Provider Demographics
NPI:1811295991
Name:ROBERTS, CHARLES (PT)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:ROBERTS
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 1:119 S MAIN ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-3647
Mailing Address - Country:US
Mailing Address - Phone:901-312-5600
Mailing Address - Fax:901-312-5605
Practice Address - Street 1:119 S MAIN ST
Practice Address - Street 2:SUITE 500
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-3647
Practice Address - Country:US
Practice Address - Phone:901-312-5600
Practice Address - Fax:901-312-5605
Is Sole Proprietor?:No
Enumeration Date:2011-03-14
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4289225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist