Healthcare Provider Details

I. General information

NPI: 1194307967
Provider Name (Legal Business Name): ANGELA ROBBINS PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2021
Last Update Date: 04/22/2021
Certification Date: 04/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6625 W LINCOLN HWY
CROWN POINT IN
46307-9678
US

IV. Provider business mailing address

8558 BROADWAY
MERRILLVILLE IN
46410-7032
US

V. Phone/Fax

Practice location:
  • Phone: 219-440-5360
  • Fax: 219-440-5361
Mailing address:
  • Phone: 219-392-7084
  • Fax: 219-703-6854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number06005796A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: