Individual
THOMAS E ROBERTSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
403 S GEAR AVE STE 105, WEST BURLINGTON, IA 52655-1068
(319) 752-5129
(319) 752-5164
Mailing address
PO BOX 5387, BLOOMINGTON, IL 61702-5387
(309) 661-8823
(309) 661-8801
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
004095
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000656
IOWA ATHLETIC TRAINER'S LICENSE
IA
01
—
004095
IOWA PHYSICAL THERAPY LICENSE
IA
Enumeration date
04/06/2011
Last updated
04/06/2011
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