Healthcare Provider Details

I. General information

NPI: 1225639396
Provider Name (Legal Business Name): EMILY ROBINSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2020
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4597 HIGHWAY 115
DEMOREST GA
30535-3153
US

IV. Provider business mailing address

4597 HIGHWAY 115
DEMOREST GA
30535-3153
US

V. Phone/Fax

Practice location:
  • Phone: 706-949-0770
  • Fax:
Mailing address:
  • Phone: 706-949-0770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT015046
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: