Provider Demographics
NPI:1558309500
Name:ROBLE, THOMAS JAY (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:JAY
Last Name:ROBLE
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3378 11TH ST
Mailing Address - Street 2:APT 4D
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-4962
Mailing Address - Country:US
Mailing Address - Phone:917-403-1264
Mailing Address - Fax:
Practice Address - Street 1:75 E GUN HILL RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2103
Practice Address - Country:US
Practice Address - Phone:718-798-1000
Practice Address - Fax:718-798-5522
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0270111171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor