Provider Demographics
NPI:1558634022
Name:ROBERGE, MARC DANIEL (LMT)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:DANIEL
Last Name:ROBERGE
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 E ARENAS RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-7139
Mailing Address - Country:US
Mailing Address - Phone:925-708-6441
Mailing Address - Fax:
Practice Address - Street 1:1750 E ARENAS RD
Practice Address - Street 2:SUITE 1
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-7139
Practice Address - Country:US
Practice Address - Phone:925-708-6441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-14
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist