Healthcare Provider Details

I. General information

NPI: 1760778831
Provider Name (Legal Business Name): ROBIN LYNETTE BADGER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ROBIN LYNETTE BRUMMETT PT

II. Dates (important events)

Enumeration Date: 06/27/2011
Last Update Date: 06/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25117 SW PARKWAY AVE STE D
WILSONVILLE OR
97070-9697
US

IV. Provider business mailing address

600 S 5TH ST
LEBANON OR
97355-2605
US

V. Phone/Fax

Practice location:
  • Phone: 541-570-3665
  • Fax:
Mailing address:
  • Phone: 541-852-2499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number1063
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: