Provider Demographics
NPI:1508990987
Name:ROBERTSON, KYLE ANN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:KYLE
Middle Name:ANN
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 MORGAN DR
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-1753
Mailing Address - Country:US
Mailing Address - Phone:978-777-2258
Mailing Address - Fax:
Practice Address - Street 1:11 MORGAN DR
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-1753
Practice Address - Country:US
Practice Address - Phone:978-777-2258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2264174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist