Healthcare Provider Details

I. General information

NPI: 1326098690
Provider Name (Legal Business Name): CHAD ROBERTS PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 08/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 TOWN CT
PALM COAST FL
32164-2589
US

IV. Provider business mailing address

PO BOX 1975
ROME GA
30162-1975
US

V. Phone/Fax

Practice location:
  • Phone: 386-313-5974
  • Fax: 866-647-2045
Mailing address:
  • Phone: 706-236-2755
  • Fax: 866-647-2045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT007632
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT19497
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: