Provider Demographics
NPI:1912223165
Name:ROBERTS, KEVIN MATHIS (AT,C , M ED)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:MATHIS
Last Name:ROBERTS
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Gender:M
Credentials:AT,C , M ED
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Mailing Address - Street 1:10590 TOWN CENTER DR STE 100
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-0361
Mailing Address - Country:US
Mailing Address - Phone:909-948-1124
Mailing Address - Fax:
Practice Address - Street 1:10590 TOWN CENTER DR STE 100
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-0361
Practice Address - Country:US
Practice Address - Phone:909-948-1124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-13
Last Update Date:2010-04-13
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer