Healthcare Provider Details

I. General information

NPI: 1639262629
Provider Name (Legal Business Name): ROBYN CLAIRE MOUG PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26419 N NORTH RD
DEER PARK WA
99006-9368
US

IV. Provider business mailing address

26419 N NORTH RD
DEER PARK WA
99006-9368
US

V. Phone/Fax

Practice location:
  • Phone: 509-710-9825
  • Fax: 509-276-1455
Mailing address:
  • Phone: 509-710-9825
  • Fax: 509-276-1455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License NumberPT00006116
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: