Provider Demographics
NPI:1902812043
Name:ROBINSON, MARK (PT, DPT, MSPT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:PT, DPT, MSPT
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 950248
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0248
Mailing Address - Country:US
Mailing Address - Phone:502-489-5730
Mailing Address - Fax:502-489-5753
Practice Address - Street 1:10216 TAYLORSVILLE RD
Practice Address - Street 2:900A
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-3616
Practice Address - Country:US
Practice Address - Phone:812-284-0852
Practice Address - Fax:812-284-3727
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY004625225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY186592Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER