Provider Demographics
NPI:1821040205
Name:ROBERTS, FAITH ANN (ATC)
Entity Type:Individual
Prefix:
First Name:FAITH
Middle Name:ANN
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11665 SE TORCH LAKE DR
Mailing Address - Street 2:
Mailing Address - City:ALDEN
Mailing Address - State:MI
Mailing Address - Zip Code:49612-9544
Mailing Address - Country:US
Mailing Address - Phone:231-331-4592
Mailing Address - Fax:
Practice Address - Street 1:550 MUNSON AVE
Practice Address - Street 2:MCHC OUTPATIENT REHAB
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-3580
Practice Address - Country:US
Practice Address - Phone:231-935-9176
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer