Provider Demographics
NPI:1205488590
Name:ROBERTS, MICHELLE E (DPT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:E
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 S SANGAMON ST STE 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-5167
Mailing Address - Country:US
Mailing Address - Phone:312-243-9350
Mailing Address - Fax:773-913-0602
Practice Address - Street 1:225 S SANGAMON ST STE 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-5167
Practice Address - Country:US
Practice Address - Phone:312-243-9350
Practice Address - Fax:773-913-0602
Is Sole Proprietor?:No
Enumeration Date:2019-07-16
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070024403208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation