Provider Demographics
NPI:1700955630
Name:CANTU, ROBERTO (PT)
Entity type:Individual
Prefix:
First Name:ROBERTO
Middle Name:
Last Name:CANTU
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 WASHINGTON ST SE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-3628
Mailing Address - Country:US
Mailing Address - Phone:678-971-1838
Mailing Address - Fax:678-971-1834
Practice Address - Street 1:301 MAIN STREET MAIN ST. SW
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501
Practice Address - Country:US
Practice Address - Phone:678-971-1838
Practice Address - Fax:678-971-1834
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA001749225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGA001749OtherSTATE LISC NUMBER