Provider Demographics
NPI:1932314523
Name:THOMAS, ROBIN LYN (PT)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:LYN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 MIDWAY ST
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:GA
Mailing Address - Zip Code:31763-4573
Mailing Address - Country:US
Mailing Address - Phone:229-594-3220
Mailing Address - Fax:
Practice Address - Street 1:251 US HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:CAMILLA
Practice Address - State:GA
Practice Address - Zip Code:31730-1410
Practice Address - Country:US
Practice Address - Phone:229-336-8255
Practice Address - Fax:229-336-5878
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT005007225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist