Provider Demographics
NPI:1679758338
Name:BLACK, ROBIN K (RPT REGISTERED PHYSI)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:K
Last Name:BLACK
Suffix:
Gender:F
Credentials:RPT REGISTERED PHYSI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 HOLT LANE
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926
Mailing Address - Country:US
Mailing Address - Phone:530-343-3822
Mailing Address - Fax:530-892-2624
Practice Address - Street 1:1585 BUTTE HOUSE RD
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95993-2200
Practice Address - Country:US
Practice Address - Phone:530-751-9340
Practice Address - Fax:530-673-0151
Is Sole Proprietor?:No
Enumeration Date:2007-12-31
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT9534225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist