Provider Demographics
NPI:1801974035
Name:OSBORN, ROBERT KENT (PT MTC)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:KENT
Last Name:OSBORN
Suffix:
Gender:M
Credentials:PT MTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 STRICKLAND DR SW
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-1844
Mailing Address - Country:US
Mailing Address - Phone:770-568-7118
Mailing Address - Fax:
Practice Address - Street 1:1675 CUMBERLAND PKWY SE
Practice Address - Street 2:SUITE 202
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080
Practice Address - Country:US
Practice Address - Phone:770-568-7118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2251X0800X, 261QP2000X
GA005434225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA65BBCZDMedicare ID - Type Unspecified