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Individual
BRIAN CLIFFORD ROBERTS
Active
Individual
BRIAN CLIFFORD ROBERTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PROVIDER CODE 22
PROVIDER CODE 22 (RESPIRATORY, REHABILITATIVE & RESTORATIVE SERVICE PROVIDERS)
PA
Enumeration date
04/12/2013
Last updated
04/12/2013
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