Provider Demographics
NPI:1417155664
Name:ROBERTS, TRACI S (LICENSED PHYSICAL TH)
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:S
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:LICENSED PHYSICAL TH
Other - Prefix:
Other - First Name:TRACI
Other - Middle Name:
Other - Last Name:SPRAKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LICENSED PHYSICAL TH
Mailing Address - Street 1:342 VIRGINIA AVENUE
Mailing Address - Street 2:HEARTLAND REHABILITATION SERVICES OF VIRGINIA INC
Mailing Address - City:WYTHEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24382
Mailing Address - Country:US
Mailing Address - Phone:276-228-6200
Mailing Address - Fax:276-228-9175
Practice Address - Street 1:342 VIRGINIA AVENUE
Practice Address - Street 2:HEARTLAND REHABILITATION SERVICES OF VIRGINIA INC
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382
Practice Address - Country:US
Practice Address - Phone:276-228-6200
Practice Address - Fax:276-228-9175
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306001038225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant