MEDICARE: JIM J ROBERTSON P.T.

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	3276	CO

Other Identifiers

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

General Provider Information

NPI Number	:	1457552101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JIM J ROBERTSON P.T.

Provider Business Mailing Address
First Line	:	185 STAFFORD LN
Second Line	:	PO BOX 827
City	:	DELTA
State	:	CO
Zip	:	81416-2229
Country	:	US
Telephone Number	:	970-874-5747
Fax Number	:	970-874-8187

Provider Business Practice Location Address
First Line	:	185 STAFFORD LN
Second Line	:
City	:	DELTA
State	:	CO
Zip	:	81416-2229
Country	:	US
Telephone Number	:	970-874-5747
Fax Number	:	970-874-8187

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

Provider Enumeration Date	:	05/30/2007
Last Update Date	:	12/09/2011

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