Provider Demographics
NPI:1841440658
Name:LEBEAU, ROBERT CARL (PTA)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:CARL
Last Name:LEBEAU
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 ELM ST
Mailing Address - Street 2:
Mailing Address - City:COSHOCTON
Mailing Address - State:OH
Mailing Address - Zip Code:43812-2221
Mailing Address - Country:US
Mailing Address - Phone:740-610-5373
Mailing Address - Fax:
Practice Address - Street 1:75 MCMILLEN DR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-1808
Practice Address - Country:US
Practice Address - Phone:740-344-0357
Practice Address - Fax:740-344-0456
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-29
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA-6947314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility