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
1	225100000X	Physical Therapist	PT2261	FL

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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