Provider Demographics
NPI:1558068908
Name:TAFOLLA, ROBERT BENJAMIN (DPT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:BENJAMIN
Last Name:TAFOLLA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1122 HONEY CRK
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78132-3453
Mailing Address - Country:US
Mailing Address - Phone:210-854-7661
Mailing Address - Fax:
Practice Address - Street 1:5001 SCHERTZ PKWY
Practice Address - Street 2:
Practice Address - City:SCHERTZ
Practice Address - State:TX
Practice Address - Zip Code:78154-1478
Practice Address - Country:US
Practice Address - Phone:210-305-5713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1373742225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist