Provider Demographics
NPI:1912038209
Name:ROBERSON, LINDA K S (MPT)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:K S
Last Name:ROBERSON
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3148
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27895-3148
Mailing Address - Country:US
Mailing Address - Phone:252-243-9629
Mailing Address - Fax:252-243-0915
Practice Address - Street 1:1803 FOREST HILLS ROAD
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893
Practice Address - Country:US
Practice Address - Phone:252-243-9629
Practice Address - Fax:252-243-0915
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14502251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0791YOtherBCBS
187209OtherMEDCOST
NC7590420OtherAETNA
NC0791YOtherBCBS
NC2507651Medicare ID - Type Unspecified