Provider Demographics
NPI:1013103928
Name:ROBERTS, JOSHUA M (ATC)
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:M
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100-4 DRISCOLL LANE
Mailing Address - Street 2:
Mailing Address - City:WOOD DALE
Mailing Address - State:IL
Mailing Address - Zip Code:60191
Mailing Address - Country:US
Mailing Address - Phone:815-593-0421
Mailing Address - Fax:630-833-4438
Practice Address - Street 1:533 S YORK RD STE D
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-4467
Practice Address - Country:US
Practice Address - Phone:630-833-4437
Practice Address - Fax:630-833-4438
Is Sole Proprietor?:No
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL096.00224172255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer