Healthcare Provider Details

I. General information

NPI: 1689668667
Provider Name (Legal Business Name): JOEL B ROBB PT, ATC, SCS, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 03/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4102 PINION DR
USAF ACADEMY CO
80840-2502
US

IV. Provider business mailing address

4102 PINION DR
USAF ACADEMY CO
80840-2502
US

V. Phone/Fax

Practice location:
  • Phone: 719-333-5942
  • Fax:
Mailing address:
  • Phone: 719-333-3107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number6192
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number040402228
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL.0012140
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: