MEDICARE: REBECCA RENEE ROBERTSON DPT

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	225100000X	Physical Therapist	PT 23186	FL

General Provider Information

NPI Number	:	1386857373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA RENEE ROBERTSON DPT

Provider Business Mailing Address
First Line	:	515 GERONA RD
Second Line	:
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32086-6205
Country	:	US
Telephone Number	:	904-794-1067
Fax Number	:

Provider Business Practice Location Address
First Line	:	1422 SAN MARCO BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-8536
Country	:	US
Telephone Number	:	877-990-0090
Fax Number	:	904-398-4148

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

Provider Enumeration Date	:	05/07/2007
Last Update Date	:	07/08/2007

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