MEDICARE: ALAN BOYD ROBERTS 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	6220378-2401	UT

General Provider Information

NPI Number	:	1457324287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALAN BOYD ROBERTS PT

Provider Business Mailing Address
First Line	:	754 S 125 W
Second Line	:
City	:	LAYTON
State	:	UT
Zip	:	84041-3543
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1950 CIRCLE OF HOPE DR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84112-5500
Country	:	US
Telephone Number	:	801-587-4023
Fax Number	:

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

Provider Enumeration Date	:	02/10/2006
Last Update Date	:	07/08/2007

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