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General NPI Number Information
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NPI Number | 1053526152
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Entity Type | Individual
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Provider Name | PATRICIA (TRISHA) BETTY ROBERTS RPT
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Gender | Female
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Dates
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Enumeration Date | 05/11/2007
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Last Update Date | 04/02/2020
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Provider Practice Location Address
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Address Line | 24 HOLLYWOOD BLVD SW STE 7
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City | FORT WALTON BEACH
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State | FL
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Zip | 32548-4893
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Country | US
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Telephone | 850-226-7411
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Fax | 850-226-7496
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Provider Business Mailing Address
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Address Line | 24 HOLLYWOOD BLVD SW STE 7
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City | FORT WALTON BEACH
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State | FL
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Zip | 32548-4893
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Country | US
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Telephone | 850-226-7411
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 05001208A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 33400
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 33400
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License Number State | FL
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