Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PTH4086 | AL |
NPI | 1003105024 |
---|---|
Provider Name | Mrs. Melissa Robinett |
First Address | Mountain Brk, AL 35213-3313 |
Second Address | Mountain Brk, AL 35213-3313 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2011 |
Last Update Date | 30/03/2011 |