Provider Demographics
NPI:1184055147
Name:ROBERTS, SHERMAN LEON JR (PT, DPT)
Entity type:Individual
Prefix:
First Name:SHERMAN
Middle Name:LEON
Last Name:ROBERTS
Suffix:JR
Gender:
Credentials:PT, DPT
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 629
Mailing Address - Street 2:
Mailing Address - City:MAULDIN
Mailing Address - State:SC
Mailing Address - Zip Code:29662-0629
Mailing Address - Country:US
Mailing Address - Phone:803-779-8327
Mailing Address - Fax:803-799-3603
Practice Address - Street 1:1519 TAYLOR ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2918
Practice Address - Country:US
Practice Address - Phone:803-779-8327
Practice Address - Fax:803-799-3603
Is Sole Proprietor?:No
Enumeration Date:2013-12-02
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7229225100000X
NCP19818225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC7229OtherSC BOARD OF PT EXAMINERS
NCP19818OtherNC BOARD OF PHYSICAL THERAPY EXAMINERS