Provider Demographics
NPI:1780260828
Name:ROBINSON, BRYANT ANTON (EP)
Entity type:Individual
Prefix:
First Name:BRYANT
Middle Name:ANTON
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:EP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41232 CANTON CT
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-1469
Mailing Address - Country:US
Mailing Address - Phone:734-383-3631
Mailing Address - Fax:
Practice Address - Street 1:16127 WICK RD
Practice Address - Street 2:
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-1462
Practice Address - Country:US
Practice Address - Phone:313-800-3303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-19
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI224Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist