Provider Demographics
NPI:1558437335
Name:ROBERTS, BARBARA F (P,T)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:F
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:P,T
Other - Prefix:MRS
Other - First Name:BARBIE
Other - Middle Name:F
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:310 VANDENBERG DR
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39531-6164
Mailing Address - Country:US
Mailing Address - Phone:847-924-6108
Mailing Address - Fax:
Practice Address - Street 1:11975 SEAWAY RD
Practice Address - Street 2:SUITE A226
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-6015
Practice Address - Country:US
Practice Address - Phone:228-896-2824
Practice Address - Fax:228-896-2825
Is Sole Proprietor?:No
Enumeration Date:2006-11-26
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070012139225100000X
MSPT 5031225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist