Provider Demographics
NPI:1164988291
Name:ROBERTSON, DENISE ANNE (ATC)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:ANNE
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19558 OAKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92377-4055
Mailing Address - Country:US
Mailing Address - Phone:909-472-6645
Mailing Address - Fax:
Practice Address - Street 1:19558 OAKLAND AVE
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92377-4055
Practice Address - Country:US
Practice Address - Phone:909-472-6645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer