Provider Demographics
NPI:1043720592
Name:ROBINSON, DETERRIYON (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:DETERRIYON
Middle Name:
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 DAUPHINE LN
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-6344
Mailing Address - Country:US
Mailing Address - Phone:318-393-3571
Mailing Address - Fax:
Practice Address - Street 1:3055 BARDIN RD STE 200
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-3819
Practice Address - Country:US
Practice Address - Phone:972-522-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-10
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXCP039041T225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist