Healthcare Provider Details

I. General information

NPI: 1508047663
Provider Name (Legal Business Name): DAVID R ROBERTSON JR. DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2007
Last Update Date: 02/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 AMANA AVE
FAYETTEVILLE TN
37334-3365
US

IV. Provider business mailing address

18306 CROWNE BROOK CIR
FRANKLIN TN
37067-1678
US

V. Phone/Fax

Practice location:
  • Phone: 931-433-7156
  • Fax:
Mailing address:
  • Phone: 706-766-3632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number7961
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: