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General NPI Number Information
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NPI Number | 1588476576
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Entity Type | Individual
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Provider Name | ZACHARY ROBERTS
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Gender | Male
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Dates
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Enumeration Date | 01/25/2025
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Last Update Date | 01/30/2025
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Provider Practice Location Address
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Address Line | 1901 N TELEGRAPH RD
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City | WATERFORD
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State | MI
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Zip | 48328-1878
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Country | US
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Telephone | 248-836-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 3730 BIRCH ST
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City | CLARKSTON
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State | MI
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Zip | 48348-1308
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Country | US
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Telephone |
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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 |
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License Number State |
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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 | 5502008735
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License Number State | MI
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