Provider Demographics
NPI:1134545254
Name:ROBERTSON, MARJORIE SHERYL (PT)
Entity type:Individual
Prefix:MRS
First Name:MARJORIE
Middle Name:SHERYL
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:MARJORIE
Other - Middle Name:SHERYL
Other - Last Name:MINER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:147 SW SHEVLIN HIXON DR STE 104
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3185
Mailing Address - Country:US
Mailing Address - Phone:541-312-2252
Mailing Address - Fax:541-312-8822
Practice Address - Street 1:147 SW SHEVLIN HIXON DR STE 104
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3185
Practice Address - Country:US
Practice Address - Phone:541-312-2252
Practice Address - Fax:541-312-8822
Is Sole Proprietor?:No
Enumeration Date:2014-03-13
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR60863225100000X
NY009442-12251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic