Provider Demographics
NPI:1134357841
Name:ROBERTS, CARLENE (CMT)
Entity type:Individual
Prefix:
First Name:CARLENE
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 685
Mailing Address - Street 2:
Mailing Address - City:MARIPOSA
Mailing Address - State:CA
Mailing Address - Zip Code:95338-0685
Mailing Address - Country:US
Mailing Address - Phone:209-742-8153
Mailing Address - Fax:
Practice Address - Street 1:49722 ROAD 426 STE 101
Practice Address - Street 2:
Practice Address - City:OAKHURST
Practice Address - State:CA
Practice Address - Zip Code:93644-9048
Practice Address - Country:US
Practice Address - Phone:559-683-4434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-01
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist