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NPI Code Detail

MEDICARE: MISS TRACY ANNE ROBERTS PTA

MEDICARE: MISS TRACY ANNE ROBERTS PTA
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
1225200000XPhysical Therapy Assistant001528IA

General Provider Information

NPI Number : 1578928768
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS TRACY ANNE ROBERTS PTA
Provider Business Mailing Address
First Line : 1010 LONGVIEW RD
Second Line :
City : MISSOURI VALLEY
State : IA
Zip : 51555-1227
Country : US
Telephone Number : 712-642-4700
Fax Number :
Provider Business Practice Location Address
First Line : 1010 LONGVIEW RD
Second Line :
City : MISSOURI VALLEY
State : IA
Zip : 51555-1227
Country : US
Telephone Number : 712-642-4700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/15/2015
Last Update Date : 12/15/2015

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Directions to “ MISS TRACY ANNE ROBERTS PTA” Practice Location

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