Healthcare Provider Details

I. General information

NPI: 1043790728
Provider Name (Legal Business Name): RENEE C ROBERTS DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2018
Last Update Date: 08/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4710 OLD TROY PIKE
DAYTON OH
45424-5740
US

IV. Provider business mailing address

2641 HIBISCUS WAY APT 320
BEAVERCREEK OH
45431-2399
US

V. Phone/Fax

Practice location:
  • Phone: 937-233-1230
  • Fax: 937-236-8930
Mailing address:
  • Phone: 440-334-8081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT017644
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: