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General NPI Number Information
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NPI Number | 1124906987
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Entity Type | Individual
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Provider Name | JACOB ROBERTS PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 08/21/2025
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Last Update Date | 08/21/2025
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Provider Practice Location Address
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Address Line | 15820 SHADDOCK DR STE 110
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City | WINTER GARDEN
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State | FL
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Zip | 34787-5775
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Country | US
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Telephone | 321-999-9056
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Fax |
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Provider Business Mailing Address
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Address Line | 2680 N ORANGE AVE APT 1422
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City | ORLANDO
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State | FL
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Zip | 32804-4736
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Country | US
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Telephone | 228-860-0477
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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