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Organization
PSA HEALTHCARE
Active
Organization
PSA HEALTHCARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. THERESA ROBINSON MS-CCC-SLP (SPEECH LANGUAGE PATHOLOGIST)
(478) 841-2772
Entity
Organization
Contact information
Practice address
770 BACONSFIELD DR, BUILDING 1, MACON, GA 31211-1400
(478) 841-2772
(478) 841-2644
Mailing address
770 BACONSFIELD DR, BUILDING 1, MACON, GA 31211-1400
(478) 841-2772
(478) 841-2644
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT002429
GA
225100000X
Physical Therapist
PT002435
GA
225X00000X
Occupational Therapist
OT003589
GA
235Z00000X
Speech-Language Pathologist
SLP001909
GA
235Z00000X
Speech-Language Pathologist
SLP005082
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000699784F
—
GA
05
—
000760702C
—
GA
05
—
000868238C
—
GA
05
—
000913844D
—
GA
05
—
000954665B
—
GA
Enumeration date
12/26/2006
Last updated
08/01/2008
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