Provider Demographics
NPI:1346342839
Name:ROBERTS & ASSOCIATES PHYSICAL THERAPY SC
Entity Type:Organization
Organization Name:ROBERTS & ASSOCIATES PHYSICAL THERAPY SC
Other - Org Name:ROBERTS PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:715-529-3487
Mailing Address - Street 1:PO BOX 324
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:WI
Mailing Address - Zip Code:54406-0324
Mailing Address - Country:US
Mailing Address - Phone:715-529-3487
Mailing Address - Fax:715-251-6236
Practice Address - Street 1:621 8TH ST S
Practice Address - Street 2:
Practice Address - City:WISCONSIN RAPIDS
Practice Address - State:WI
Practice Address - Zip Code:54494-5019
Practice Address - Country:US
Practice Address - Phone:715-529-3487
Practice Address - Fax:715-251-6236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-04
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIDE6363OtherMEDICARE RR
WI=========012OtherBC/BS GROUP ID NUMBER
WI000083346Medicare PIN