Provider Demographics
NPI:1134330228
Name:ROBERTS, TYRONE P (LMT)
Entity Type:Individual
Prefix:
First Name:TYRONE
Middle Name:P
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 S. GARDEN AVE.
Mailing Address - Street 2:#3
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-5529
Mailing Address - Country:US
Mailing Address - Phone:813-802-5589
Mailing Address - Fax:727-953-8995
Practice Address - Street 1:411 S. GARDEN AVE.
Practice Address - Street 2:#3
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-5529
Practice Address - Country:US
Practice Address - Phone:813-802-5589
Practice Address - Fax:727-953-8995
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 47862225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist