Provider Demographics
NPI:1326425653
Name:ROBERTS, JUSTIN (LMT)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
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 1:11211 PROSPERITY FARMS RD
Mailing Address - Street 2:SUITE D223
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-3487
Mailing Address - Country:US
Mailing Address - Phone:561-214-5858
Mailing Address - Fax:561-627-9231
Practice Address - Street 1:11211 PROSPERITY FARMS RD
Practice Address - Street 2:SUITE D223
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-3487
Practice Address - Country:US
Practice Address - Phone:561-214-5858
Practice Address - Fax:561-627-9231
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-06
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA67589225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist