Provider Demographics
NPI:1457596033
Name:ROBLES, EDISON G (PT)
Entity Type:Individual
Prefix:
First Name:EDISON
Middle Name:G
Last Name:ROBLES
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 1:10015 OLD COLUMBIA RD
Mailing Address - Street 2:SUITE B 215
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-1703
Mailing Address - Country:US
Mailing Address - Phone:410-356-6161
Mailing Address - Fax:
Practice Address - Street 1:1311 CONTINENTAL DR
Practice Address - Street 2:SUITE R
Practice Address - City:ABINGDON
Practice Address - State:MD
Practice Address - Zip Code:21009-2333
Practice Address - Country:US
Practice Address - Phone:410-676-0997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-10
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22751225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist