Healthcare Provider Details

I. General information

NPI: 1629460928
Provider Name (Legal Business Name): DEDRA MICHELLE ROBISON LPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2015
Last Update Date: 02/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 NEW KING ST SUITE 105
WHITE PLAINS NY
10604-1205
US

IV. Provider business mailing address

819 CHEROKEE LN
SIGNAL MOUNTAIN TN
37377-3014
US

V. Phone/Fax

Practice location:
  • Phone: 914-390-9880
  • Fax: 914-390-9881
Mailing address:
  • Phone: 256-997-3028
  • Fax: 423-805-2294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License NumberPTA5192
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: