Provider Demographics
NPI:1891533246
Name:DEAN, ROBERT ALLEN JR
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:ALLEN
Last Name:DEAN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:785 OAKLEAF PLANTATION PKWY UNIT 122
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-3535
Mailing Address - Country:US
Mailing Address - Phone:985-278-8141
Mailing Address - Fax:
Practice Address - Street 1:785 OAKLEAF PLANTATION PKWY UNIT 122
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32065-3535
Practice Address - Country:US
Practice Address - Phone:985-278-8141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL33409225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant