MEDICARE: PATRICK ROBERTS MS, ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1336763929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICK ROBERTS MS, ATC

Provider Business Mailing Address
First Line	:	4714 GETTYSBURG RD
Second Line	:
City	:	MECHANICSBURG
State	:	PA
Zip	:	17055-4325
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1032 W SHERIDAN RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60660-1537
Country	:	US
Telephone Number	:	773-274-3000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2020
Last Update Date	:	05/30/2020

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