Provider Demographics
NPI:1245574045
Name:ROBERTS, KARA J (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:J
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 51246
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42102-5546
Mailing Address - Country:US
Mailing Address - Phone:270-726-6640
Mailing Address - Fax:270-726-6674
Practice Address - Street 1:103 KEETON DR
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-8756
Practice Address - Country:US
Practice Address - Phone:270-726-6640
Practice Address - Fax:270-726-6674
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY006140174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty