Provider Demographics
NPI:1982824777
Name:ROBERTS, KAYE ELLEN (PT)
Entity Type:Individual
Prefix:MS
First Name:KAYE
Middle Name:ELLEN
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5810 ANNARUE PL
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43231-2902
Mailing Address - Country:US
Mailing Address - Phone:614-794-2062
Mailing Address - Fax:
Practice Address - Street 1:4019 W DUBLIN GRANVILLE RD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-1436
Practice Address - Country:US
Practice Address - Phone:614-293-0043
Practice Address - Fax:614-293-6962
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT-1195225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1195OtherPHYSICAL THERAPIST