1114211836 NPI number — ASHLEY LONG ROBINSON P.T.

Table of content: ASHLEY LONG ROBINSON P.T. (NPI 1114211836)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114211836 NPI number — ASHLEY LONG ROBINSON P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBINSON
Provider First Name:
ASHLEY
Provider Middle Name:
LONG
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LONG
Provider Other First Name:
ASHLEY
Provider Other Middle Name:
MICHELLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
P.T.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1114211836
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/01/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 32569
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KNOXVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37930-2569
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-694-0062
Provider Business Mailing Address Fax Number:
865-694-7907

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9430 PARK WEST BLVD
Provider Second Line Business Practice Location Address:
STE 235
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37923-4200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-560-8550
Provider Business Practice Location Address Fax Number:
865-560-8551
Provider Enumeration Date:
05/31/2011

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:  8942 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1525243 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com