Provider Demographics
NPI:1063296838
Name:MAIN, ROBERT ALAN III (DPT)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:ALAN
Last Name:MAIN
Suffix:III
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2001 BUTTERFIELD RD STE 1600
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1211
Mailing Address - Country:US
Mailing Address - Phone:866-370-8206
Mailing Address - Fax:517-435-3670
Practice Address - Street 1:2645 ANNAPOLIS RD STE B
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MD
Practice Address - Zip Code:21076-2280
Practice Address - Country:US
Practice Address - Phone:443-351-2063
Practice Address - Fax:410-551-5634
Is Sole Proprietor?:No
Enumeration Date:2023-08-23
Last Update Date:2025-11-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OKCP032198T225100000X
COCP029541T225100000X
FL42977225100000X
MDCP050406T225100000X
SCCP038449T225100000X
AZCP026798T225100000X
TX138552225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist