Provider Demographics
NPI:1578708822
Name:ROBIDOUX, CHARLES GREGORY (RPT)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:GREGORY
Last Name:ROBIDOUX
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:110 FLORENCE ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-3966
Mailing Address - Country:US
Mailing Address - Phone:781-321-7000
Mailing Address - Fax:781-322-9678
Practice Address - Street 1:110 FLORENCE ST
Practice Address - Street 2:SUITE 104
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-3966
Practice Address - Country:US
Practice Address - Phone:781-321-7000
Practice Address - Fax:781-322-9678
Is Sole Proprietor?:No
Enumeration Date:2008-12-15
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA13167225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist