Provider Demographics
NPI:1508047663
Name:ROBERTSON, DAVID R JR (DPT)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:R
Last Name:ROBERTSON
Suffix:JR
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18306 CROWNE BROOK CIR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-1678
Mailing Address - Country:US
Mailing Address - Phone:706-766-3632
Mailing Address - Fax:
Practice Address - Street 1:501 AMANA AVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37334-3365
Practice Address - Country:US
Practice Address - Phone:931-433-7156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-16
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7961225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist