Provider Demographics
NPI:1639647472
Name:BELLER, ROBERTA (PT)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:
Last Name:BELLER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 N PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-4090
Mailing Address - Country:US
Mailing Address - Phone:508-830-6990
Mailing Address - Fax:
Practice Address - Street 1:20 N PARK AVE STE 1300
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-4090
Practice Address - Country:US
Practice Address - Phone:508-830-6990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-09
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9668225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist