Provider Demographics
NPI:1437364197
Name:FRIEDMAN, ROBERTA RUTH (PT)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:RUTH
Last Name:FRIEDMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4402 E CREOSOTE DR
Mailing Address - Street 2:
Mailing Address - City:CAVE CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85331-3898
Mailing Address - Country:US
Mailing Address - Phone:480-540-8697
Mailing Address - Fax:
Practice Address - Street 1:4402 E CREOSOTE DR
Practice Address - Street 2:
Practice Address - City:CAVE CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85331-3898
Practice Address - Country:US
Practice Address - Phone:480-540-8697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5717225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist