Healthcare Provider Details

I. General information

NPI: 1730322959
Provider Name (Legal Business Name): JENNIFER SUE ROBERTS P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2009
Last Update Date: 08/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7447 N UNIVERSITY DR
TAMARAC FL
33321-2970
US

IV. Provider business mailing address

363 NW 158TH AVE
PEMBROKE PINES FL
33028-1587
US

V. Phone/Fax

Practice location:
  • Phone: 954-720-1530
  • Fax:
Mailing address:
  • Phone: 954-450-8715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT0016563
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: