Basic Information
| Provider Information | |||||||||
| NPI: | 1235508284 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROBINSON | ||||||||
| FirstName: | KELLIE | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | |||||||||
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| Credential: | PT, DPT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | FORREST | ||||||||
| OtherFirstName: | KELLIE | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | PT, DPT | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 317 N EL CAMINO REAL STE 210 | ||||||||
| Address2: | |||||||||
| City: | ENCINITAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920242813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7606340248 | ||||||||
| FaxNumber: | 7606341782 | ||||||||
| Practice Location | |||||||||
| Address1: | 1663 GREENFIELD DR | ||||||||
| Address2: | |||||||||
| City: | EL CAJON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920213520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6194405752 | ||||||||
| FaxNumber: | 6194406861 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2015 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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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 | 225100000X | 292960 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.