Provider Demographics
NPI:1700163615
Name:ROBBINS, SETH M (MED, ATC, CSCS, EMT)
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:M
Last Name:ROBBINS
Suffix:
Gender:M
Credentials:MED, ATC, CSCS, EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 AVENEL BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH WALES
Mailing Address - State:PA
Mailing Address - Zip Code:19454-3942
Mailing Address - Country:US
Mailing Address - Phone:267-688-2388
Mailing Address - Fax:
Practice Address - Street 1:1105 AVENEL BLVD
Practice Address - Street 2:
Practice Address - City:NORTH WALES
Practice Address - State:PA
Practice Address - Zip Code:19454-3942
Practice Address - Country:US
Practice Address - Phone:267-688-2388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-05
Last Update Date:2011-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0195024102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA22Medicaid