Provider Demographics
NPI:1255534475
Name:EDBERG, ROBIN JUNE (PTA)
Entity type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:JUNE
Last Name:EDBERG
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 1:9219 CRAVER RD
Mailing Address - Street 2:
Mailing Address - City:MORONGO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92256
Mailing Address - Country:US
Mailing Address - Phone:760-363-1111
Mailing Address - Fax:
Practice Address - Street 1:72201 COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270
Practice Address - Country:US
Practice Address - Phone:760-340-5999
Practice Address - Fax:760-568-6787
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT1213225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant