Individual
MR. RANDY LEE ROBERTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPTA
Contact information
Practice address
2575 N DRAKE RD, KALAMAZOO, MI 49006-1358
(269) 342-0206
Mailing address
2575 N DRAKE RD, KALAMAZOO, MI 49006-1358
(269) 342-0206
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
5502002106
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5502002106
MICHIGAN LICENSE
MI
Enumeration date
12/06/2013
Last updated
12/06/2013
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