Healthcare Provider Details

I. General information

NPI: 1972620375
Provider Name (Legal Business Name): FREDRICK L. ROBINSON ATC, LAT, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 J R LYNCH ST
JACKSON MS
39217-0002
US

IV. Provider business mailing address

PO BOX 1722
BRANDON MS
39043-1722
US

V. Phone/Fax

Practice location:
  • Phone: 601-979-7032
  • Fax:
Mailing address:
  • Phone: 601-825-4495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: