1639357098 NPI number — LAUREN VERONICA ROBSON OT

Table of content: LAUREN VERONICA ROBSON OT (NPI 1639357098)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639357098 NPI number — LAUREN VERONICA ROBSON OT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBSON
Provider First Name:
LAUREN
Provider Middle Name:
VERONICA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639357098
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1301 EAST BIDWELL STREET, SUITE 201
Provider Second Line Business Mailing Address:
BURGER REHABILITATION SYSTEMS, INC.
Provider Business Mailing Address City Name:
FOLSOM
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95630
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-983-5915
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2800 ESTATES DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRFIELD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94533-9712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-432-1200
Provider Business Practice Location Address Fax Number:
707-426-1130
Provider Enumeration Date:
02/07/2008

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: 225X00000X , with the licence number:  525 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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