Provider Demographics
NPI:1326370214
Name:ROBERTS, LASANDRA A (RRT)
Entity Type:Individual
Prefix:MRS
First Name:LASANDRA
Middle Name:A
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60133 WILLIAMS YOUNG RD
Mailing Address - Street 2:
Mailing Address - City:SMITHVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38870-9788
Mailing Address - Country:US
Mailing Address - Phone:662-651-5196
Mailing Address - Fax:
Practice Address - Street 1:404 9TH AVE S
Practice Address - Street 2:
Practice Address - City:AMORY
Practice Address - State:MS
Practice Address - Zip Code:38821-5414
Practice Address - Country:US
Practice Address - Phone:662-257-0535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSRCP04952279P1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279P1005XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredPulmonary Rehabilitation