Provider Demographics
NPI:1104832252
Name:ROBERTSON, BRETT W (MPT)
Entity Type:Individual
Prefix:MR
First Name:BRETT
Middle Name:W
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 NATURE PARK RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-6960
Mailing Address - Country:US
Mailing Address - Phone:724-689-0571
Mailing Address - Fax:
Practice Address - Street 1:118 NATURE PARK RD
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-6960
Practice Address - Country:US
Practice Address - Phone:724-689-0571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT023942225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
S876 0011OtherFEDERAL BCBS
MD618668-01OtherCAREFIRST BCBS
MD2102810OtherMAMSI
MD21-6662Medicare ID - Type Unspecified
MD7352552OtherAETNA