Basic Information
| Provider Information | |||||||||
| NPI: | 1659784361 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROBERTSON | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | GEORGE | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5334 MEADOW LANE CT | ||||||||
| Address2: | |||||||||
| City: | SHEFFIELD VILLAGE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440351469 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4409345454 | ||||||||
| FaxNumber: | 4409348975 | ||||||||
| Practice Location | |||||||||
| Address1: | 5334 MEADOW LANE CT | ||||||||
| Address2: | |||||||||
| City: | SHEFFIELD VILLAGE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440351469 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4409345454 | ||||||||
| FaxNumber: | 4409348975 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2014 | ||||||||
| LastUpdateDate: | 06/10/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT014745 | OH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.