Provider Demographics
NPI:1093700650
Name:ROBERGE, NANCY J (PT DPT MED)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:J
Last Name:ROBERGE
Suffix:
Gender:F
Credentials:PT DPT MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 LINDEN ST
Mailing Address - Street 2:STE B-8
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02482-7900
Mailing Address - Country:US
Mailing Address - Phone:781-263-9977
Mailing Address - Fax:
Practice Address - Street 1:148 LINDEN ST
Practice Address - Street 2:STE B-8
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02482-7900
Practice Address - Country:US
Practice Address - Phone:781-263-9977
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2530225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY65631OtherBCBS
MAY65631OtherBCBS