Provider Demographics
NPI:1861752933
Name:ROBERTS, ANDREA M (PT)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:M
Last Name:ROBERTS
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 1:323 E TOWN ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-4753
Mailing Address - Country:US
Mailing Address - Phone:614-461-8174
Mailing Address - Fax:614-461-9155
Practice Address - Street 1:323 E TOWN ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-4753
Practice Address - Country:US
Practice Address - Phone:614-461-8174
Practice Address - Fax:614-461-9155
Is Sole Proprietor?:No
Enumeration Date:2012-05-23
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT.011999225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPT.011999OtherSTATE LICENSE