Healthcare Provider Details

I. General information

NPI: 1861787079
Provider Name (Legal Business Name): TINA ROBINSON GELLER MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TINA ROBINSON

II. Dates (important events)

Enumeration Date: 06/15/2011
Last Update Date: 03/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15200 W SUNSET BLVD 111
PACIFIC PALISADES CA
90272-3619
US

IV. Provider business mailing address

24630 WASHINGTON AVE 200
MURRIETA CA
92562-6177
US

V. Phone/Fax

Practice location:
  • Phone: 310-573-9340
  • Fax: 310-573-9328
Mailing address:
  • Phone: 951-696-9353
  • Fax: 951-973-7216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 36921
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: