Provider Demographics
NPI:1538340435
Name:TYSON, ROBIN LYNN (LMT)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:LYNN
Last Name:TYSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 EDGEWOOD DR
Mailing Address - Street 2:APT 2
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-6613
Mailing Address - Country:US
Mailing Address - Phone:419-467-1155
Mailing Address - Fax:
Practice Address - Street 1:1215 RIDGEWOOD DR
Practice Address - Street 2:STE A
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-2690
Practice Address - Country:US
Practice Address - Phone:419-352-0142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-19
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH8492225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist