Provider Demographics
NPI:1972202018
Name:ROBERTSON, MARIA DOMINIQUE (DPT)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:DOMINIQUE
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1627 SUMMERWIND DR
Mailing Address - Street 2:
Mailing Address - City:FERNLEY
Mailing Address - State:NV
Mailing Address - Zip Code:89408-7208
Mailing Address - Country:US
Mailing Address - Phone:541-589-3469
Mailing Address - Fax:
Practice Address - Street 1:6630 S MCCARRAN BLVD STE A6
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-6136
Practice Address - Country:US
Practice Address - Phone:775-828-2866
Practice Address - Fax:775-828-2891
Is Sole Proprietor?:No
Enumeration Date:2023-02-27
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist