Provider Demographics
NPI:1992260608
Name:ROBINSON, DOROTHY GWENDOLYN (PTA)
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:GWENDOLYN
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4285 LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32446-2919
Mailing Address - Country:US
Mailing Address - Phone:386-292-0802
Mailing Address - Fax:
Practice Address - Street 1:4285 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-2919
Practice Address - Country:US
Practice Address - Phone:386-292-0802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-06
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL27933208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLN0675045807-8OtherHEALTHCARE PROVIDERS SERVICE ORGANIZATION