MEDICARE: MRS. LYNN P ROBERTSON PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	018856-1	NY

General Provider Information

NPI Number	:	1053488254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LYNN P ROBERTSON PT

Provider Business Mailing Address
First Line	:	790 REMINGTON BLVD
Second Line	:
City	:	BOLINGBROOK
State	:	IL
Zip	:	60440-4909
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2183A RALPH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-5405
Country	:	US
Telephone Number	:	718-451-1400
Fax Number	:	718-451-2797

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	06/27/2024

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