MEDICARE: AMBER 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	1278958	TX

General Provider Information

NPI Number	:	1770039992
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBER ROBERTS PT

Provider Business Mailing Address
First Line	:	400 N ALLEN DR. #104
Second Line	:
City	:	ALLEN
State	:	TX
Zip	:	75013
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 N ALLEN DR STE 104
Second Line	:
City	:	ALLEN
State	:	TX
Zip	:	75013-2575
Country	:	US
Telephone Number	:	972-727-1931
Fax Number	:

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

Provider Enumeration Date	:	08/28/2016
Last Update Date	:	08/28/2016

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