Provider Demographics
NPI:1336524081
Name:ROBLE, VICTOR (CIT)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:
Last Name:ROBLE
Suffix:
Gender:M
Credentials:CIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1463
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72811-1463
Mailing Address - Country:US
Mailing Address - Phone:479-968-7086
Mailing Address - Fax:479-968-7225
Practice Address - Street 1:400 LAKE FRONT DR
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72802-2206
Practice Address - Country:US
Practice Address - Phone:479-968-7086
Practice Address - Fax:479-968-7225
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-23
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor