Provider Demographics
NPI:1639635600
Name:ROBAK, AUBREY LYNLEE (PTA)
Entity type:Individual
Prefix:
First Name:AUBREY
Middle Name:LYNLEE
Last Name:ROBAK
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12927 9 MILE RD
Mailing Address - Street 2:
Mailing Address - City:KALEVA
Mailing Address - State:MI
Mailing Address - Zip Code:49645-9736
Mailing Address - Country:US
Mailing Address - Phone:231-690-9862
Mailing Address - Fax:
Practice Address - Street 1:210 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:MI
Practice Address - Zip Code:49635-9745
Practice Address - Country:US
Practice Address - Phone:231-352-9674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-14
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502005707208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation