Provider Demographics
NPI:1568728822
Name:ROOBOL, TEGAN WETHERBEE (DPT)
Entity Type:Individual
Prefix:
First Name:TEGAN
Middle Name:WETHERBEE
Last Name:ROOBOL
Suffix:
Gender:F
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:PO BOX 323
Mailing Address - Street 2:
Mailing Address - City:FOWLERVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48836-0323
Mailing Address - Country:US
Mailing Address - Phone:517-223-8308
Mailing Address - Fax:517-223-8344
Practice Address - Street 1:125 E. GRAND RIVER
Practice Address - Street 2:FOWLERVILLE PHYSICAL THERAPY SPECIALISTS
Practice Address - City:FOWLERVILLE
Practice Address - State:MI
Practice Address - Zip Code:48836
Practice Address - Country:US
Practice Address - Phone:517-223-8308
Practice Address - Fax:517-223-8344
Is Sole Proprietor?:No
Enumeration Date:2012-04-11
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501015846225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist