Provider Demographics
NPI:1801254230
Name:ROBINSON, JACOB (PT, DPT)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36867 COOK ST STE 103
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-6064
Mailing Address - Country:US
Mailing Address - Phone:800-489-6905
Mailing Address - Fax:
Practice Address - Street 1:36867 COOK ST STE 103
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-6064
Practice Address - Country:US
Practice Address - Phone:800-489-6905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-30
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43587225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist