Healthcare Provider Details

I. General information

NPI: 1093232142
Provider Name (Legal Business Name): ROBERT SOLOMON OSBORNE PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2017
Last Update Date: 04/08/2024
Certification Date: 01/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 E REDSTONE AVE STE B
CRESTVIEW FL
32539-5370
US

IV. Provider business mailing address

405 SCARBOROUGH ST
CRESTVIEW FL
32539-6769
US

V. Phone/Fax

Practice location:
  • Phone: 850-398-8600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number40915
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: