Provider Demographics
NPI:1609158559
Name:ROBERTS, JOHN CHARLES JR (MSED, ATC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:CHARLES
Last Name:ROBERTS
Suffix:JR
Gender:M
Credentials:MSED, ATC
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Mailing Address - Street 1:PO BOX 1000
Mailing Address - Street 2:CONCORD UNIVERSITY
Mailing Address - City:ATHENS
Mailing Address - State:WV
Mailing Address - Zip Code:24712-1000
Mailing Address - Country:US
Mailing Address - Phone:304-384-6346
Mailing Address - Fax:304-384-5331
Practice Address - Street 1:1000 VERMILLION ST
Practice Address - Street 2:CONCORD UNIVERSITY
Practice Address - City:ATHENS
Practice Address - State:WV
Practice Address - Zip Code:24712-9027
Practice Address - Country:US
Practice Address - Phone:304-384-6346
Practice Address - Fax:304-384-5331
Is Sole Proprietor?:No
Enumeration Date:2011-09-16
Last Update Date:2014-07-31
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Provider Licenses
StateLicense IDTaxonomies
VA01260003762255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer