MEDICARE: JONATHAN ROEBER

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	2305209698	VA

General Provider Information

NPI Number	:	1487021218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN ROEBER

Provider Business Mailing Address
First Line	:	5080 VILLAGE HWY
Second Line	:
City	:	LYNCHBURG
State	:	VA
Zip	:	24504-5380
Country	:	US
Telephone Number	:	607-341-6746
Fax Number	:

Provider Business Practice Location Address
First Line	:	5080 VILLAGE HWY
Second Line	:
City	:	LYNCHBURG
State	:	VA
Zip	:	24504-5380
Country	:	US
Telephone Number	:	607-341-6746
Fax Number	:

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

Provider Enumeration Date	:	08/27/2015
Last Update Date	:	08/27/2015

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Directions to “ JONATHAN ROEBER ” Practice Location

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