Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225CA2400X | Assistive Technology Practitioner | ATP87109 | IL |
Y | 226300000X | Kinesiotherapist | 1888 | IL |
NPI | 1447787429 |
---|---|
Provider Name | Mr. Travon Robinson |
First Address | Dallas, TX 75380-1034 |
Second Address | Dallas, TX 75216-7167 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2017 |
Last Update Date | 11/09/2018 |