Healthcare Provider Details

I. General information

NPI: 1659578995
Provider Name (Legal Business Name): JODI ROBINETTE PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 W WARNER RD SUITE 102
TEMPE AZ
85284-1906
US

IV. Provider business mailing address

13625 S 48TH ST APT 2163
PHOENIX AZ
85044-5000
US

V. Phone/Fax

Practice location:
  • Phone: 480-735-0124
  • Fax:
Mailing address:
  • Phone: 480-343-2789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number7727A
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: