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NPI Code Detail

MEDICARE: DAVID RALPH ROBERTS JR. PT

MEDICARE:   DAVID RALPH ROBERTS JR. 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 TherapistPT2261FL

General Provider Information

NPI Number : 1578558508
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID RALPH ROBERTS JR. PT
Provider Business Mailing Address
First Line : 16403 SPRING VALLEY RD
Second Line :
City : DADE CITY
State : FL
Zip : 33523-6343
Country : US
Telephone Number : 352-518-0505
Fax Number : 866-291-4106
Provider Business Practice Location Address
First Line : 16403 SPRING VALLEY RD
Second Line :
City : DADE CITY
State : FL
Zip : 33523-6343
Country : US
Telephone Number : 352-518-0505
Fax Number : 866-291-4106
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/15/2005
Last Update Date : 08/13/2007

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Directions to “ DAVID RALPH ROBERTS JR. PT” Practice Location

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