Provider Demographics
NPI:1396904603
Name:DYSARD, ROBIN (PT)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:DYSARD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19559 DEMING LN
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-6555
Mailing Address - Country:US
Mailing Address - Phone:239-949-7000
Mailing Address - Fax:
Practice Address - Street 1:19559 DEMING LN
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-6555
Practice Address - Country:US
Practice Address - Phone:239-949-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT22861225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist