Provider Demographics
NPI:1710419478
Name:ROBERTS, TRESSIA DIANE (PT)
Entity Type:Individual
Prefix:MRS
First Name:TRESSIA
Middle Name:DIANE
Last Name:ROBERTS
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 1:1185 W CARMEL DR BLDG C
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-8708
Mailing Address - Country:US
Mailing Address - Phone:317-582-8922
Mailing Address - Fax:317-582-8926
Practice Address - Street 1:1185 W CARMEL DR BLDG C
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-8708
Practice Address - Country:US
Practice Address - Phone:317-582-8922
Practice Address - Fax:317-582-8926
Is Sole Proprietor?:No
Enumeration Date:2017-03-31
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05002224A2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic