Provider Demographics
NPI:1790481620
Name:ROEBLE, RON JAMES (CTRS)
Entity Type:Individual
Prefix:MR
First Name:RON
Middle Name:JAMES
Last Name:ROEBLE
Suffix:
Gender:M
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7130 TURKEY RUN DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46815-7734
Mailing Address - Country:US
Mailing Address - Phone:216-316-0765
Mailing Address - Fax:
Practice Address - Street 1:7130 TURKEY RUN DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46815-7734
Practice Address - Country:US
Practice Address - Phone:216-316-0765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist