Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | 10813 | CT |
NPI | 1003218447 |
---|---|
Provider Name | Mr. Robert Joseph Roller JR. |
First Address | Fort Bragg, NC 28310-7324 |
Second Address | Fort Bragg, NC 28310-7324 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2014 |
Last Update Date | 06/02/2022 |