=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447280029
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAY CODY ROBISON MPT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/03/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9341 MIDWAY SUITE C
-----------------------------------------------------
City | DURHAM
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95938-9785
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-343-2010
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 515 LUDS WAY
-----------------------------------------------------
City | OROVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95965-9284
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-532-8876
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT 24808
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------