Individual
BRIAN CLIFFORD ROBERTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
526 PANTHER LN, ROME, PA 18837-7892
(570) 744-2521
Mailing address
116 WALNUT ST, ATHENS, PA 18810-1723
(570) 888-0818
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PROVIDER CODE 22
PROVIDER CODE 22 (RESPIRATORY, REHABILITATIVE & RESTORATIVE SERVICE PROVIDERS)
PA
Enumeration date
04/12/2013
Last updated
04/12/2013
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