Provider Demographics
NPI:1154538445
Name:ROBINSON, GARY R (MS, PT, PCS)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:R
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:MS, PT, PCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 391
Mailing Address - Street 2:
Mailing Address - City:TISHOMINGO
Mailing Address - State:OK
Mailing Address - Zip Code:73460-0391
Mailing Address - Country:US
Mailing Address - Phone:580-310-4314
Mailing Address - Fax:580-371-9844
Practice Address - Street 1:ONE MURRAY CAMPUS
Practice Address - Street 2:NAH #108
Practice Address - City:TISHOMINGO
Practice Address - State:OK
Practice Address - Zip Code:73460-0391
Practice Address - Country:US
Practice Address - Phone:580-310-4314
Practice Address - Fax:580-371-9844
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11082251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics