Provider Demographics
NPI:1003606773
Name:PRATER, ROBERT M (PHYSICAL THEAPIST)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:M
Last Name:PRATER
Suffix:
Gender:
Credentials:PHYSICAL THEAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2059 CONDOR CT
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-7959
Mailing Address - Country:US
Mailing Address - Phone:303-324-6242
Mailing Address - Fax:
Practice Address - Street 1:2059 CONDOR CT
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80503-7959
Practice Address - Country:US
Practice Address - Phone:303-324-6242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00006760225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist