Individual
MICHAEL JESSIE VISITA ROBERTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
1648 ST. VINCENTS WAY, 100B, MIDDLEBURG, FL 32068
(904) 214-3083
Mailing address
301 SCARLET BUGLER LN S, JACKSONVILLE, FL 32225-3937
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA27840
FL
Other
Enumeration date
09/14/2017
Last updated
09/14/2017
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