Provider Demographics
NPI:1508004177
Name:ROBILLAR, ERICA J (LMT)
Entity Type:Individual
Prefix:MISS
First Name:ERICA
Middle Name:J
Last Name:ROBILLAR
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 1:4731 TURNSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32812-1557
Mailing Address - Country:US
Mailing Address - Phone:407-432-6250
Mailing Address - Fax:
Practice Address - Street 1:100 BURNSED PL
Practice Address - Street 2:STE 1020
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-6695
Practice Address - Country:US
Practice Address - Phone:407-432-6250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-04
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA41216171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA41216OtherFLORIDA STATE MASSAGE LICENSE