Provider Demographics
NPI:1265535587
Name:ROBINSON, MICHAEL JASON (PT,DPT,CSCS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JASON
Last Name:ROBINSON
Suffix:
Gender:
Credentials:PT,DPT,CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1748 E BROAD ST STE 120
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-3400
Mailing Address - Country:US
Mailing Address - Phone:817-477-4567
Mailing Address - Fax:817-477-4591
Practice Address - Street 1:1748 E BROAD ST STE 120
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-3400
Practice Address - Country:US
Practice Address - Phone:817-477-4567
Practice Address - Fax:817-477-4591
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPTL226862251X0800X
IL070-014659225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00249518OtherRAILROAD MEDICARE NUMBER
ILP00249518OtherRAILROAD MEDICARE NUMBER
ILK2343Medicare ID - Type Unspecified