Provider Demographics
NPI:1811909831
Name:ROBINSON, TERRY MACK JR (PT)
Entity type:Individual
Prefix:MR
First Name:TERRY
Middle Name:MACK
Last Name:ROBINSON
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
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Mailing Address - Street 1:204 N DOOLEY ST STE 300
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-9207
Mailing Address - Country:US
Mailing Address - Phone:817-481-3451
Mailing Address - Fax:817-481-2543
Practice Address - Street 1:204 N DOOLEY ST STE 300
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-9207
Practice Address - Country:US
Practice Address - Phone:817-481-3451
Practice Address - Fax:817-481-2543
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX1055077225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX75-2727132OtherTAX ID