Provider Demographics
NPI:1861573818
Name:ROBISON, CORAL D (DPT)
Entity type:Individual
Prefix:MRS
First Name:CORAL
Middle Name:D
Last Name:ROBISON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:CORAL
Other - Middle Name:D
Other - Last Name:OLTMANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13506 DYNASTY DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDER
Mailing Address - State:AR
Mailing Address - Zip Code:72002-7254
Mailing Address - Country:US
Mailing Address - Phone:501-455-6178
Mailing Address - Fax:
Practice Address - Street 1:9601 INTERSTATE 630 EXIT 7
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-7299
Practice Address - Country:US
Practice Address - Phone:501-202-1305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPT2854225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist