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Individual

DR. LEO E ROBERTSON III

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PT

Contact information

Practice address
134 S STATE ST, PRESTON, ID 83263
(208) 852-4122
(208) 852-7187
Mailing address
44 N 1ST E, PRESTON, ID 83263-1326
(208) 852-4122
(208) 852-7187

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-2026
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1346465887
ID
05
D5960
UT
01
PT-2026
PHYSICAL THERAPY LICENSE
ID
Enumeration date
04/17/2007
Last updated
07/05/2018
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