Individual
CHARLES WAYNE ROBERTSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
2725 N WESTWOOD BLVD, POPLAR BLUFF, MO 63901-2346
(573) 778-9348
(573) 778-3463
Mailing address
2725 N WESTWOOD BLVD, POPLAR BLUFF, MO 63901-2346
(573) 778-9348
(573) 778-3463
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2000161109
MO
Other
Enumeration date
09/10/2008
Last updated
09/10/2008
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