=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366569022
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GEORGETTE M ROBINSON PTA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9000 SW 137TH AVE SUITE 116
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33186-1411
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-382-9991
-----------------------------------------------------
Fax | 305-382-9550
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14501 SW 111TH TER
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33186-6697
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-386-6452
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225200000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Assistant
-----------------------------------------------------
License Number | 20799
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------