Provider Demographics
NPI:1033368030
Name:ROBERSON, DAWN BRILEY (PTA)
Entity Type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:BRILEY
Last Name:ROBERSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 STATON CT STE F
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-9076
Mailing Address - Country:US
Mailing Address - Phone:252-758-9907
Mailing Address - Fax:252-758-9908
Practice Address - Street 1:102 STATON CT STE F
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-9076
Practice Address - Country:US
Practice Address - Phone:252-758-9907
Practice Address - Fax:252-758-9908
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-15
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2223225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty