Provider Demographics
NPI:1457597908
Name:ROBELEN, JOANNE (LMT)
Entity Type:Individual
Prefix:MS
First Name:JOANNE
Middle Name:
Last Name:ROBELEN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CROW CANYON CT
Mailing Address - Street 2:STE 200
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1980
Mailing Address - Country:US
Mailing Address - Phone:714-795-9250
Mailing Address - Fax:
Practice Address - Street 1:10 CROW CANYON CT
Practice Address - Street 2:STE 200
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1980
Practice Address - Country:US
Practice Address - Phone:714-795-9250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-05
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
173C00000X
NM6153225700000X
CA5395225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No173C00000XOther Service ProvidersReflexologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM27-0788172OtherEIN