Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | PT010398 | GA |
Y | 225100000X | Physical Therapist | PTH8137 | AL |
NPI | 1003197880 |
---|---|
Provider Name | Derron Maurice Robinson |
First Address | Vestavia, AL 35243-4415 |
Second Address | Winfield, AL 35594-5062 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2011 |
Last Update Date | 23/03/2017 |