Basic Information
Provider Information
NPI: 1194063412
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SILVER
FirstName: ROBYN
MiddleName: BLACKSTONE
NamePrefix:  
NameSuffix:  
Credential: P.T.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 9480 BRIAR VILLAGE PT
Address2:  
City: COLORADO SPRINGS
State: CO
PostalCode: 809207922
CountryCode: US
TelephoneNumber: 7192661788
FaxNumber: 7192647706
Practice Location
Address1: 9480 BRIAR VILLAGE PT
Address2:  
City: COLORADO SPRINGS
State: CO
PostalCode: 809207922
CountryCode: US
TelephoneNumber: 7192661788
FaxNumber: 7192647706
Other Information
ProviderEnumerationDate: 01/21/2013
LastUpdateDate: 10/24/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000XPTL.0011956COY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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