Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 33400 | FL |
N | 2251P0200X | Physical Therapist - Pediatrics | 05001208A | IN |
Y | 2251P0200X | Physical Therapist - Pediatrics | 33400 | FL |
NPI | 1053526152 |
---|---|
Provider Name | Patricia (trisha) Betty Roberts |
First Address | Fort Walton Beach, FL 32548-4893 |
Second Address | Fort Walton Beach, FL 32548-4893 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2007 |
Last Update Date | 02/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1053526152 | (05) | FL |