1790794816 NPI number — HOLLY JANE ROBERTS PHYSICAL THERAPIST

Table of content: HOLLY JANE ROBERTS PHYSICAL THERAPIST (NPI 1790794816)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790794816 NPI number — HOLLY JANE ROBERTS PHYSICAL THERAPIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBERTS
Provider First Name:
HOLLY
Provider Middle Name:
JANE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHYSICAL THERAPIST
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790794816
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
USAMEDDAC WUERZBURG, UNIT 26610
Provider Second Line Business Mailing Address:
ATTN: CREDENTIALS OFFICE
Provider Business Mailing Address City Name:
APO
Provider Business Mailing Address State Name:
AE
Provider Business Mailing Address Postal Code:
09244
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
011499318043
Provider Business Mailing Address Fax Number:
011499318043

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
USAHC BAMBERG UNIT 27528
Provider Second Line Business Practice Location Address:
US ARMY HEALTH CLINIC--BAMBERG
Provider Business Practice Location Address City Name:
APO
Provider Business Practice Location Address State Name:
AE
Provider Business Practice Location Address Postal Code:
09139
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
499513008677
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171000000X , with the licence number:  20005 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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