Provider Demographics
NPI:1942826151
Name:FORTIN, ROBYN GRACE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:ROBYN
Middle Name:GRACE
Last Name:FORTIN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1807 NE 2ND ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34470-6957
Mailing Address - Country:US
Mailing Address - Phone:352-622-2115
Mailing Address - Fax:
Practice Address - Street 1:1807 NE 2ND ST
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-6957
Practice Address - Country:US
Practice Address - Phone:352-622-2115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-23
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA15774225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist