Provider Demographics
NPI:1023322658
Name:WEBSTER, ROBIN LYNN (DPT)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:LYNN
Last Name:WEBSTER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:LYNN
Other - Last Name:WITHERELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:9190 MAPLEDALE RD
Mailing Address - Street 2:
Mailing Address - City:HORTON
Mailing Address - State:MI
Mailing Address - Zip Code:49246-9023
Mailing Address - Country:US
Mailing Address - Phone:517-262-1199
Mailing Address - Fax:
Practice Address - Street 1:2151 FERGUSON RD
Practice Address - Street 2:SUITE 101
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-5563
Practice Address - Country:US
Practice Address - Phone:517-748-7747
Practice Address - Fax:517-748-7745
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-06
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501015290225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist