Basic Information
Provider Information
NPI: 1689624736
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ROBSON
FirstName: LAURA
MiddleName: REEVES
NamePrefix: MRS.
NameSuffix:  
Credential: P.T.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: REEVES
OtherFirstName: LAURA
OtherMiddleName: KATHERINE
OtherNamePrefix: MISS
OtherNameSuffix:  
OtherCredential: P.T.
OtherLastNameType: 1
Mailing Information
Address1: 311 JONESVILLE RD
Address2:  
City: SIMPSONVILLE
State: SC
PostalCode: 296812645
CountryCode: US
TelephoneNumber: 8643806013
FaxNumber:  
Practice Location
Address1: 319 MILLS AVE
Address2:  
City: GREENVILLE
State: SC
PostalCode: 296054021
CountryCode: US
TelephoneNumber: 8642331153
FaxNumber: 8642714487
Other Information
ProviderEnumerationDate: 05/11/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: X
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X5096SCY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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