Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251S0007X | Physical Therapist - Sports | 047223 | NY |
Y | 2251X0800X | Physical Therapist - Orthopedic | 047223 | NY |
NPI | 1023686524 |
---|---|
Provider Name | Dr. Paul Douglas Robertson |
First Address | Rye Brook, NY 10573-1369 |
Second Address | Purchase, NY 10577-2574 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2021 |
Last Update Date | 05/11/2021 |