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NPI Code Detail

MEDICARE: CHEVON ROBERTSON DPT

MEDICARE: CHEVON ROBERTSON DPT
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 Therapist021129PA
2225100000XPhysical Therapist002919WV

General Provider Information

NPI Number : 1689972697
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHEVON ROBERTSON DPT
Provider Business Mailing Address
First Line : 511 PAYNE HILL RD
Second Line : APT #117C
City : JEFFERSON HILLS
State : PA
Zip : 15025-4040
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 511 PAYNE HILL RD
Second Line : APT #117C
City : JEFFERSON HILLS
State : PA
Zip : 15025-4040
Country : US
Telephone Number : 304-281-3639
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/01/2011
Last Update Date : 04/12/2011

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