Provider Demographics
NPI:1629460928
Name:ROBISON, DEDRA MICHELLE (LPTA)
Entity type:Individual
Prefix:MRS
First Name:DEDRA
Middle Name:MICHELLE
Last Name:ROBISON
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:819 CHEROKEE LN
Mailing Address - Street 2:
Mailing Address - City:SIGNAL MOUNTAIN
Mailing Address - State:TN
Mailing Address - Zip Code:37377-3014
Mailing Address - Country:US
Mailing Address - Phone:256-997-3028
Mailing Address - Fax:423-805-2294
Practice Address - Street 1:10 NEW KING ST
Practice Address - Street 2:SUITE 105
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10604-1205
Practice Address - Country:US
Practice Address - Phone:914-390-9880
Practice Address - Fax:914-390-9881
Is Sole Proprietor?:No
Enumeration Date:2015-02-23
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTA51922251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics