Provider Demographics
NPI:1831524966
Name:ROBERTSON, JONI M (PT)
Entity type:Individual
Prefix:
First Name:JONI
Middle Name:M
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 730052
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32173-0052
Mailing Address - Country:US
Mailing Address - Phone:901-581-4539
Mailing Address - Fax:
Practice Address - Street 1:3612 CHRISTA CT
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-2874
Practice Address - Country:US
Practice Address - Phone:901-581-4539
Practice Address - Fax:833-527-7700
Is Sole Proprietor?:No
Enumeration Date:2013-09-09
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5365225100000X, 2251X0800X
FL33143225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic