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NPI Code Detail

MEDICARE: MR. BOBBY ROBERTS II DPT

MEDICARE: MR. BOBBY ROBERTS II 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
1261QP2000XPhysical Therapy Clinic/CenterFL

General Provider Information

NPI Number : 1811785900
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BOBBY ROBERTS II DPT
Provider Business Mailing Address
First Line : 11391 SQUARE ST UNIT 1419
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32256-4097
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 500 PARK AVE
Second Line :
City : ORANGE PARK
State : FL
Zip : 32073-3132
Country : US
Telephone Number : 904-278-7890
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/28/2025
Last Update Date : 04/28/2025

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