Healthcare Provider Details

I. General information

NPI: 1871907345
Provider Name (Legal Business Name): ROBYN RENE BJORK MPT,CWS,WCC,CLT-LANA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2014
Last Update Date: 06/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15948 W CAROL DR
HAYWARD WI
54843-2560
US

IV. Provider business mailing address

15948 W CAROL DR
HAYWARD WI
54843-2560
US

V. Phone/Fax

Practice location:
  • Phone: 715-699-4434
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 26369
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: