Provider Demographics
NPI:1891265153
Name:ROBINSON, PHILIP CLIVE (LMT)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:CLIVE
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 STANFORD AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-1900
Mailing Address - Country:US
Mailing Address - Phone:859-699-6441
Mailing Address - Fax:
Practice Address - Street 1:210 STANFORD AVE STE 6
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-1900
Practice Address - Country:US
Practice Address - Phone:859-699-6441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-29
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY106748225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist