MEDICARE: MRS. CORAL D ROBISON DPT

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	225100000X	Physical Therapist	PT2854	AZ

General Provider Information

NPI Number	:	1861573818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CORAL D ROBISON DPT

Provider Business Mailing Address
First Line	:	13506 DYNASTY DR
Second Line	:
City	:	ALEXANDER
State	:	AR
Zip	:	72002-7254
Country	:	US
Telephone Number	:	501-455-6178
Fax Number	:

Provider Business Practice Location Address
First Line	:	9601 INTERSTATE 630 EXIT 7
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72205-7299
Country	:	US
Telephone Number	:	501-202-1305
Fax Number	:

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

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	07/08/2007

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