Healthcare Provider Details

I. General information

NPI: 1720796204
Provider Name (Legal Business Name): ROBIN DENISE WASHINGTON PT, PHD, CRC, FNAMRC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2022
Last Update Date: 02/16/2024
Certification Date: 02/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12254 S WENTWORTH AVE
CHICAGO IL
60628-6525
US

IV. Provider business mailing address

12254 S WENTWORTH AVE
CHICAGO IL
60628-6525
US

V. Phone/Fax

Practice location:
  • Phone: 405-401-7646
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: