Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 1352028 | TX |
N | 225100000X | Physical Therapist | 3127700 | TX |
Y | 2251S0007X | Physical Therapist - Sports | 1352028 | TX |
N | 2251S0007X | Physical Therapist - Sports | 3127700 | TX |
N | 2251X0800X | Physical Therapist - Orthopedic | 3127700 | TX |
NPI | 1417622986 |
---|---|
Provider Name | Jacob Robinson |
First Address | Dallas, TX 75231-4313 |
Second Address | Dallas, TX 75231-4313 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2021 |
Last Update Date | 11/10/2021 |