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General NPI Number Information
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NPI Number | 1295051738
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Entity Type | Individual
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Provider Name | NICOLE CAMILLE ROBERTSON PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 04/08/2010
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Last Update Date | 01/21/2025
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Provider Practice Location Address
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Address Line | 21631 RIDGETOP CIR STE 225
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City | STERLING
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State | VA
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Zip | 20166-4289
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Country | US
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Telephone | 571-207-8850
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Fax |
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Provider Business Mailing Address
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Address Line | 11850 FREEDOM DR APT 709
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City | RESTON
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State | VA
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Zip | 20190-6053
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Country | US
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Telephone | 210-687-0341
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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 | 1184713
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License Number State | TX
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