Provider Demographics
NPI:1700342599
Name:ROBINSON, THEODORE W
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:W
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4304 STATE ROUTE 45
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:OH
Mailing Address - Zip Code:44085-9702
Mailing Address - Country:US
Mailing Address - Phone:440-969-3109
Mailing Address - Fax:440-563-9406
Practice Address - Street 1:4304 STATE ROUTE 45
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:OH
Practice Address - Zip Code:44085-9702
Practice Address - Country:US
Practice Address - Phone:440-969-3109
Practice Address - Fax:440-563-9406
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-16
Last Update Date:2019-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide