Healthcare Provider Details

I. General information

NPI: 1639263270
Provider Name (Legal Business Name): DAVID STEVEN ROBERTS PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 09/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7900 CHAPIN DR NE ALLERGY, ASTHMA AND DERMATOLOGY CLINIC
NEW LONDON MN
56273
US

IV. Provider business mailing address

7900 CHAPIN DR NE ALLERGY, ASTHMA AND DERMATOLOGY CLINIC
NEW LONDON MN
56273
US

V. Phone/Fax

Practice location:
  • Phone: 320-354-4199
  • Fax:
Mailing address:
  • Phone: 320-354-4199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4398-024
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1677
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: