Provider Demographics
NPI:1679712715
Name:BAGSTER, ROBIN E (LPTA)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:E
Last Name:BAGSTER
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 SW STARFLOWER AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34984-4461
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:772-340-2414
Practice Address - Street 1:227 SW MONTEREY RD
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-4646
Practice Address - Country:US
Practice Address - Phone:772-781-1690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-12
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA20636225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant