Provider Demographics
NPI:1578640140
Name:ROBERTS, ELIZABETH (DPT, MMSC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:DPT, MMSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2530 MOUNTAIN INDUSTRIAL BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-3800
Mailing Address - Country:US
Mailing Address - Phone:404-456-3717
Mailing Address - Fax:770-270-8175
Practice Address - Street 1:2530 MOUNTAIN INDUSTRIAL BLVD STE B
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-3800
Practice Address - Country:US
Practice Address - Phone:404-456-3717
Practice Address - Fax:770-270-8175
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001598225100000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics