Provider Demographics
NPI:1871666107
Name:ROBERTSON, DANNY EUGENE (MSPT)
Entity Type:Individual
Prefix:MR
First Name:DANNY
Middle Name:EUGENE
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 PARK RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-3239
Mailing Address - Country:US
Mailing Address - Phone:704-323-2000
Mailing Address - Fax:
Practice Address - Street 1:895 STATE FARM RD STE 303
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-4917
Practice Address - Country:US
Practice Address - Phone:828-264-0501
Practice Address - Fax:828-262-0935
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP3307225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7272080Medicaid
NC75936OtherMEDCOST
NC011W4OtherBLUE CROSS BLUE SHIELD NC
NCQ43707AMedicare PIN
NC2503913Medicare PIN