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NPI Code Detail

MEDICARE: MRS. KELLY A ROBERSON PT

MEDICARE: MRS. KELLY A ROBERSON 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
1225100000XPhysical Therapist1154850TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1265475008
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KELLY A ROBERSON PT
Provider Business Mailing Address
First Line : 4206 RETAMA CIR
Second Line :
City : VICTORIA
State : TX
Zip : 77901-2765
Country : US
Telephone Number : 361-582-0611
Fax Number : 361-582-0555
Provider Business Practice Location Address
First Line : 4206 RETAMA CIR
Second Line :
City : VICTORIA
State : TX
Zip : 77901-2765
Country : US
Telephone Number : 361-582-0611
Fax Number : 361-582-0555
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2006
Last Update Date : 07/15/2009

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Directions to “ MRS. KELLY A ROBERSON PT” Practice Location

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