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General NPI Number Information
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NPI Number | 1225531064
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Entity Type | Individual
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Provider Name | CAROLINE N ROBERTS ATC, PTA
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Gender | Female
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Dates
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Enumeration Date | 03/16/2018
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Last Update Date | 01/25/2022
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Provider Practice Location Address
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Address Line | 470 E LOCKWOOD AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63119-3194
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Country | US
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Telephone | 630-876-6286
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Fax |
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Provider Business Mailing Address
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Address Line | 5065 GALENA CT
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City | IMPERIAL
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State | MO
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Zip | 63052-1587
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Country | US
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Telephone | 618-593-5820
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2018027218
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 160007639
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 096004237
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 2018027217
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License Number State | MO
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