Provider Demographics
NPI:1518510452
Name:ROBERTS, GREYSON ELLIS (DPT)
Entity Type:Individual
Prefix:
First Name:GREYSON
Middle Name:ELLIS
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:GENEVIEVE
Other - Middle Name:ELYSE
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:300 POLARIS PKWY STE 160
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-7989
Mailing Address - Country:US
Mailing Address - Phone:305-726-1574
Mailing Address - Fax:
Practice Address - Street 1:300 POLARIS PKWY STE 160
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-7989
Practice Address - Country:US
Practice Address - Phone:614-533-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT018188225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist