Provider Demographics
NPI:1215037718
Name:ROBERTS, TERI S (DPT)
Entity Type:Individual
Prefix:DR
First Name:TERI
Middle Name:S
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15300 W ROANOKE AVE
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-8979
Mailing Address - Country:US
Mailing Address - Phone:623-734-5545
Mailing Address - Fax:623-337-4692
Practice Address - Street 1:14535 W INDIAN SCHOOL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-9262
Practice Address - Country:US
Practice Address - Phone:623-734-5544
Practice Address - Fax:623-337-4692
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6814225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist