Provider Demographics
NPI:1124010897
Name:ROBEL, S. JUANITA (PT)
Entity Type:Individual
Prefix:
First Name:S.
Middle Name:JUANITA
Last Name:ROBEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:JUANITA
Other - Last Name:MAYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3200 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-4104
Mailing Address - Country:US
Mailing Address - Phone:515-271-1717
Mailing Address - Fax:515-271-7185
Practice Address - Street 1:3200 GRAND AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50312-4104
Practice Address - Country:US
Practice Address - Phone:515-271-1717
Practice Address - Fax:515-271-7185
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00867225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1124010897Medicaid
IA0232827Medicaid
P30770Medicare UPIN
IAI1846Medicare PIN