Provider Demographics
NPI:1255375291
Name:ROBERTS, ERIC DELOY (MSPT)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:DELOY
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 PEVERO DR
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-6318
Mailing Address - Country:US
Mailing Address - Phone:208-522-5600
Mailing Address - Fax:208-524-6300
Practice Address - Street 1:185 PEVERO DR
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-6318
Practice Address - Country:US
Practice Address - Phone:208-522-5600
Practice Address - Fax:208-524-6300
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-2268225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000067042Medicare ID - Type UnspecifiedPHYSICAL THERAPY