Provider Demographics
NPI:1437459856
Name:MCROBERTS, JACQUELINE EILEEN (PT)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:EILEEN
Last Name:MCROBERTS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:EILEEN
Other - Last Name:BRADY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT,
Mailing Address - Street 1:2143 GREEN OAKS CIR
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-3508
Mailing Address - Country:US
Mailing Address - Phone:512-689-4694
Mailing Address - Fax:
Practice Address - Street 1:2143 GREEN OAKS CIR
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-3508
Practice Address - Country:US
Practice Address - Phone:512-689-4694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-01
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1107787225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist