Provider Demographics
NPI:1386370450
Name:WILLIAMSON, ROBBIE (ATC)
Entity type:Individual
Prefix:
First Name:ROBBIE
Middle Name:
Last Name:WILLIAMSON
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 E NORTH LN APT D3
Mailing Address - Street 2:
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-2268
Mailing Address - Country:US
Mailing Address - Phone:585-216-7663
Mailing Address - Fax:
Practice Address - Street 1:1200 CONSTITUTION AVE STE 110
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19112-1323
Practice Address - Country:US
Practice Address - Phone:267-592-0666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0071102081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PART007110OtherPA ATC LICENSE