MEDICARE: LAURA JO ROBINSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	DI00001819	WA
2	225100000X	Physical Therapist	PT00010035	WA

General Provider Information

NPI Number	:	1033414362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA JO ROBINSON

Provider Business Mailing Address
First Line	:	1020 W RUFFNER ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98119-1475
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1009 8TH AVE N
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98109-3504
Country	:	US
Telephone Number	:	206-631-2818
Fax Number	:	206-631-2819

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2011
Last Update Date	:	01/18/2011

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