Provider Demographics
NPI:1750164950
Name:ROBINSON, ALLEN ROSS (PTA)
Entity type:Individual
Prefix:
First Name:ALLEN
Middle Name:ROSS
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 STATE ST
Mailing Address - Street 2:
Mailing Address - City:GASSAWAY
Mailing Address - State:WV
Mailing Address - Zip Code:26624-1132
Mailing Address - Country:US
Mailing Address - Phone:304-364-1063
Mailing Address - Fax:304-598-2871
Practice Address - Street 1:64 STATE ST
Practice Address - Street 2:
Practice Address - City:GASSAWAY
Practice Address - State:WV
Practice Address - Zip Code:26624-1132
Practice Address - Country:US
Practice Address - Phone:304-364-1063
Practice Address - Fax:304-598-2871
Is Sole Proprietor?:No
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV002906225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant