Healthcare Provider Details

I. General information

NPI: 1205745718
Provider Name (Legal Business Name): LYNNE DIANE ROBERTS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7428 REDWOOD BLVD
NOVATO CA
94945-2418
US

IV. Provider business mailing address

175 CABRO CT
NOVATO CA
94947-3713
US

V. Phone/Fax

Practice location:
  • Phone: 415-924-4525
  • Fax: 415-924-8167
Mailing address:
  • Phone: 415-924-4525
  • Fax: 415-924-8167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number54686
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: