Provider Demographics
NPI:1902911076
Name:ROBINSON, JASON LEE (PT)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:LEE
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 E RAILROAD ST
Mailing Address - Street 2:
Mailing Address - City:SANDWICH
Mailing Address - State:IL
Mailing Address - Zip Code:60548-2250
Mailing Address - Country:US
Mailing Address - Phone:815-313-6333
Mailing Address - Fax:815-417-6921
Practice Address - Street 1:710 E RAILROAD ST
Practice Address - Street 2:
Practice Address - City:SANDWICH
Practice Address - State:IL
Practice Address - Zip Code:60548
Practice Address - Country:US
Practice Address - Phone:815-313-6333
Practice Address - Fax:815-417-6921
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-010389225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK25113Medicare ID - Type Unspecified