Provider Demographics
NPI:1255536009
Name:HUARD, ROBERTA E (PT)
Entity type:Individual
Prefix:
First Name:ROBERTA
Middle Name:E
Last Name:HUARD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8739 STARVILLE RD
Mailing Address - Street 2:
Mailing Address - City:CLAY
Mailing Address - State:MI
Mailing Address - Zip Code:48001-3721
Mailing Address - Country:US
Mailing Address - Phone:810-794-4299
Mailing Address - Fax:
Practice Address - Street 1:421 MICHIGAN ST
Practice Address - Street 2:
Practice Address - City:ALGONAC
Practice Address - State:MI
Practice Address - Zip Code:48001-1641
Practice Address - Country:US
Practice Address - Phone:810-794-8040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501003025225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist