Provider Demographics
NPI:1417492679
Name:MC ROBERTS, ROBERT JR (CPED)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:MC ROBERTS
Suffix:JR
Gender:M
Credentials:CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 YORK ST
Mailing Address - Street 2:UNIT#3
Mailing Address - City:BLOOMER
Mailing Address - State:WI
Mailing Address - Zip Code:54724-1920
Mailing Address - Country:US
Mailing Address - Phone:715-577-9098
Mailing Address - Fax:
Practice Address - Street 1:1706 YORK ST STE 3
Practice Address - Street 2:
Practice Address - City:BLOOMER
Practice Address - State:WI
Practice Address - Zip Code:54724-1921
Practice Address - Country:US
Practice Address - Phone:715-581-5005
Practice Address - Fax:715-568-1501
Is Sole Proprietor?:No
Enumeration Date:2016-12-27
Last Update Date:2018-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthist