MEDICARE: CRAIG R ROBERTS MPT

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	05008190A	IN
2	225100000X	Physical Therapist	005392	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000491496	OTHER	IN	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417054487
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRAIG R ROBERTS MPT

Provider Business Mailing Address
First Line	:	3026 HIDDEN LAKE PT
Second Line	:
City	:	OWENSBORO
State	:	KY
Zip	:	42303-4455
Country	:	US
Telephone Number	:	270-685-9499
Fax Number	:	270-685-9443

Provider Business Practice Location Address
First Line	:	1605 SCHERM RD
Second Line	:
City	:	OWENSBORO
State	:	KY
Zip	:	42301-5300
Country	:	US
Telephone Number	:	270-685-9499
Fax Number	:	270-685-9443

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	09/04/2013

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