MEDICARE: JONI M. ROBERTSON 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	5365	TN
2	2251X0800X	Orthopedic Physical Therapist	5365	TN
3	225100000X	Physical Therapist	33143	FL

General Provider Information

NPI Number	:	1831524966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONI M. ROBERTSON PT

Provider Business Mailing Address
First Line	:	PO BOX 730052
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32173-0052
Country	:	US
Telephone Number	:	901-581-4539
Fax Number	:

Provider Business Practice Location Address
First Line	:	3612 CHRISTA CT
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-2874
Country	:	US
Telephone Number	:	901-581-4539
Fax Number	:	833-527-7700

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

Provider Enumeration Date	:	09/09/2013
Last Update Date	:	06/13/2019

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