Basic Information
| Provider Information | |||||||||
| NPI: | 1609341791 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROBINSON | ||||||||
| FirstName: | BREANNA | ||||||||
| MiddleName: | AUDREY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1364 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | READING | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018671137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8885312204 | ||||||||
| FaxNumber: | 8552328604 | ||||||||
| Practice Location | |||||||||
| Address1: | 1364 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | READING | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018671137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8885312204 | ||||||||
| FaxNumber: | 8552328604 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2018 | ||||||||
| LastUpdateDate: | 10/04/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 9491 | MA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.