Healthcare Provider Details

I. General information

NPI: 1972273001
Provider Name (Legal Business Name): GINGER ROBINSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2021
Last Update Date: 09/20/2021
Certification Date: 09/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 W IRONWOOD DR STE 102
COEUR D ALENE ID
83814-4903
US

IV. Provider business mailing address

522 W SUMMIT AVE APT 3
COEUR D ALENE ID
83814-2307
US

V. Phone/Fax

Practice location:
  • Phone: 208-966-4376
  • Fax: 208-665-5756
Mailing address:
  • Phone: 509-895-9329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMAS-4250
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: