Provider Demographics
NPI:1578558508
Name:ROBERTS, DAVID RALPH JR (PT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:RALPH
Last Name:ROBERTS
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16403 SPRING VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33523-6343
Mailing Address - Country:US
Mailing Address - Phone:352-518-0505
Mailing Address - Fax:866-291-4106
Practice Address - Street 1:16403 SPRING VALLEY RD
Practice Address - Street 2:
Practice Address - City:DADE CITY
Practice Address - State:FL
Practice Address - Zip Code:33523-6343
Practice Address - Country:US
Practice Address - Phone:352-518-0505
Practice Address - Fax:866-291-4106
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-15
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT2261225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist