Healthcare Provider Details

I. General information

NPI: 1740502376
Provider Name (Legal Business Name): SUSSETTE EIDSON ROBINSON PT,OCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2010
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

642 HIGHWAY 76
WHITE HOUSE TN
37188-9205
US

IV. Provider business mailing address

1200 CORPORATE DR STE 400
BIRMINGHAM AL
35242-5424
US

V. Phone/Fax

Practice location:
  • Phone: 615-672-4966
  • Fax:
Mailing address:
  • Phone: 423-238-7217
  • Fax: 423-238-3473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4224
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number4224
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: