Provider Demographics
NPI:1295947588
Name:DORAN, ROBIN MARIE (PT)
Entity type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:MARIE
Last Name:DORAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:ROBIN
Other - Middle Name:MARIE
Other - Last Name:BURNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:103 LOG PLAIN ROAD
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01301
Mailing Address - Country:US
Mailing Address - Phone:413-773-3515
Mailing Address - Fax:
Practice Address - Street 1:103 LOG PLAIN ROAD
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301
Practice Address - Country:US
Practice Address - Phone:413-773-3515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4453225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0377023Medicaid