Healthcare Provider Details

I. General information

NPI: 1821129495
Provider Name (Legal Business Name): MARK ERIC ROBERTSON PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 W 21ST STREET
RED LODGE MT
59068
US

IV. Provider business mailing address

PO BOX 590
RED LODGE MT
59068-0590
US

V. Phone/Fax

Practice location:
  • Phone: 406-446-1112
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1696
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: