Provider Demographics
NPI:1184369746
Name:GARRETT, ROBERT (PTA)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:GARRETT
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 FORT JESSE RD STE 230
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-6291
Mailing Address - Country:US
Mailing Address - Phone:309-661-6260
Mailing Address - Fax:
Practice Address - Street 1:2200 FORT JESSE RD STE 230
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-6291
Practice Address - Country:US
Practice Address - Phone:309-661-6260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-28
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant