Healthcare Provider Details

I. General information

NPI: 1598702136
Provider Name (Legal Business Name): JEFFREY JAMES ROBERTS MS, ATC, NASM-PES
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SAN JOSE STATE UNIVERSITY DEPARTMENT OF KINESIOLOGY
SAN JOSE CA
95192-0001
US

IV. Provider business mailing address

506 VIA SORRENTO
MORGAN HILL CA
95037-5744
US

V. Phone/Fax

Practice location:
  • Phone: 408-924-3035
  • Fax:
Mailing address:
  • Phone: 408-776-6773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225500000X
TaxonomyRespiratory/Developmental/Rehabilitative Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: