Provider Demographics
NPI:1548633530
Name:ROBINSON, ELIZABETH ANN
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:MCKINNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5601 N 37TH ST
Mailing Address - Street 2:APT WW4
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98407-2666
Mailing Address - Country:US
Mailing Address - Phone:253-202-2276
Mailing Address - Fax:
Practice Address - Street 1:5601 N 37TH ST
Practice Address - Street 2:APT WW4
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98407-2666
Practice Address - Country:US
Practice Address - Phone:253-202-2276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-12
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60615824225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist