Provider Demographics
NPI:1952539405
Name:PAULINE, ROBERT C (PT, MPT)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:C
Last Name:PAULINE
Suffix:
Gender:M
Credentials:PT, MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7257 N MAPLE AVE
Mailing Address - Street 2:SUITE D-106
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-0167
Mailing Address - Country:US
Mailing Address - Phone:559-257-3991
Mailing Address - Fax:559-275-3992
Practice Address - Street 1:7257 N MAPLE AVE
Practice Address - Street 2:SUITE D-106
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-0167
Practice Address - Country:US
Practice Address - Phone:559-257-3991
Practice Address - Fax:559-275-3992
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-23
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT34328225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist