Healthcare Provider Details

I. General information

NPI: 1982150116
Provider Name (Legal Business Name): LEE ROBINSON PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2016
Last Update Date: 08/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 GRISTMILL AVE
FOREST VA
24551
US

IV. Provider business mailing address

2600 COMPASS RD
GLENVIEW IL
60026-8001
US

V. Phone/Fax

Practice location:
  • Phone: 434-385-8506
  • Fax: 434-316-6091
Mailing address:
  • Phone: 877-787-3430
  • Fax: 847-441-0734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2306602346
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: