MEDICARE: MARK ROBB PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT12234	CA

General Provider Information

NPI Number	:	1417502659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK ROBB PT

Provider Business Mailing Address
First Line	:	1915 N RED ROCK DR
Second Line	:
City	:	WALNUT
State	:	CA
Zip	:	91789-5113
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12840 RIVERSIDE DR
Second Line	:
City	:	N HOLLYWOOD
State	:	CA
Zip	:	91607-3327
Country	:	US
Telephone Number	:	818-506-5197
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2019
Last Update Date	:	08/05/2019

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Directions to “ MARK ROBB PT” Practice Location

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