Provider Demographics
NPI:1528463437
Name:ROBINSON, RUSSELL II (PTA)
Entity type:Individual
Prefix:
First Name:RUSSELL
Middle Name:
Last Name:ROBINSON
Suffix:II
Gender:M
Credentials:PTA
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 306806
Mailing Address - Street 2:
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00803-6806
Mailing Address - Country:US
Mailing Address - Phone:340-626-8302
Mailing Address - Fax:
Practice Address - Street 1:1001 ESTATE ROSS STE 8
Practice Address - Street 2:
Practice Address - City:ST THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802-4600
Practice Address - Country:US
Practice Address - Phone:340-626-8302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-04
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA4190225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant