Provider Demographics
NPI:1265989693
Name:KINSMAN, ROBERT GEORGE (PT)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:GEORGE
Last Name:KINSMAN
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 1:11808 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-3613
Mailing Address - Country:US
Mailing Address - Phone:877-230-3885
Mailing Address - Fax:
Practice Address - Street 1:11808 GRANT ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-3613
Practice Address - Country:US
Practice Address - Phone:877-230-3885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA025434225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist