Provider Demographics
NPI:1134166432
Name:ROBINSON, GREGORY B (PT)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:B
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:MARCUS HOOK
Mailing Address - State:PA
Mailing Address - Zip Code:19061-4513
Mailing Address - Country:US
Mailing Address - Phone:610-859-8850
Mailing Address - Fax:610-859-7876
Practice Address - Street 1:4709 KIRKWOOD HIGHWAY
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-5007
Practice Address - Country:US
Practice Address - Phone:302-998-9880
Practice Address - Fax:302-998-7498
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0001272225100000X
PAPT009185225100000X
DEJ1001272225100000X
PAPT009185L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA30077846OtherKEYSTONE MERCY
PA2081151OtherHIGHMARK PA BLUE SHIELD
DE000050143OtherDPCI
PA102439896-0001Medicaid
DEP00359639OtherRAILROAD MEDICARE
DE1134166432Medicaid
DE3747010000OtherIBC
DEG02348D01Medicare PIN