Provider Demographics
NPI:1487220133
Name:ROBERTS, MIKAYLA GRACE REGISTER (PT)
Entity Type:Individual
Prefix:
First Name:MIKAYLA
Middle Name:GRACE REGISTER
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MIKAYLA
Other - Middle Name:GRACE
Other - Last Name:REGISTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14 LITTLEJOHN GLEN CT
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-5791
Mailing Address - Country:US
Mailing Address - Phone:864-288-2998
Mailing Address - Fax:864-288-3522
Practice Address - Street 1:14 LITTLEJOHN GLEN CT
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-5791
Practice Address - Country:US
Practice Address - Phone:864-288-2998
Practice Address - Fax:864-288-3522
Is Sole Proprietor?:No
Enumeration Date:2021-06-02
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10698225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist