MEDICARE: HAILEY JORDAN ROBERSON

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

General Provider Information

NPI Number	:	1114607678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAILEY JORDAN ROBERSON

Provider Business Mailing Address
First Line	:	100 4TH AVE S APT 400
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33701-4374
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4020 PARK ST N STE 101
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33709-4030
Country	:	US
Telephone Number	:	727-388-4688
Fax Number	:

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

Provider Enumeration Date	:	07/20/2023
Last Update Date	:	07/20/2023

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Directions to “ HAILEY JORDAN ROBERSON ” Practice Location

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