Provider Demographics
NPI:1457535890
Name:ROBERTS, LAURA MICHELE (PT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MICHELE
Last Name:ROBERTS
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 1:115 112TH AVE NE
Mailing Address - Street 2:APT 917
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716-3278
Mailing Address - Country:US
Mailing Address - Phone:727-954-8015
Mailing Address - Fax:
Practice Address - Street 1:5935 4TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33703-1417
Practice Address - Country:US
Practice Address - Phone:727-526-7726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-20
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL234862251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic