Provider Demographics
NPI:1952790024
Name:THEIS, ROBIN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:
Last Name:THEIS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:ROBIN
Other - Middle Name:
Other - Last Name:SHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:2550 S STATE ROUTE 100
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-9356
Mailing Address - Country:US
Mailing Address - Phone:419-447-7203
Mailing Address - Fax:419-447-5577
Practice Address - Street 1:2550 S STATE ROUTE 100
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-9356
Practice Address - Country:US
Practice Address - Phone:419-447-7203
Practice Address - Fax:419-447-5577
Is Sole Proprietor?:No
Enumeration Date:2015-01-13
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA2010225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant