1003855891 NPI number — ROBIN S GLINKA MPT, ATC

Table of content: ROBIN S GLINKA MPT, ATC (NPI 1003855891)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003855891 NPI number — ROBIN S GLINKA MPT, ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GLINKA
Provider First Name:
ROBIN
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MPT, ATC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COLLINS
Provider Other First Name:
ROBIN
Provider Other Middle Name:
S
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MPT, ATC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1003855891
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/04/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
35008 EMERALD COAST PKWY
Provider Second Line Business Mailing Address:
STE 400
Provider Business Mailing Address City Name:
DESTIN
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32541-4753
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-687-9416
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
35008 EMERALD COAST PKWY STE 400
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DESTIN
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32541-4753
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-714-6166
Provider Business Practice Location Address Fax Number:
850-714-6167
Provider Enumeration Date:
06/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT 16800 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: PT22209 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 891320000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: AC932Z . This is a "MEDICARE PTAN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 116762400 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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