Provider Demographics
NPI:1427457720
Name:ROEBUCK, FLOYD
Entity type:Individual
Prefix:MR
First Name:FLOYD
Middle Name:
Last Name:ROEBUCK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12880 MORSEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BIRCH RUN
Mailing Address - State:MI
Mailing Address - Zip Code:48415-8787
Mailing Address - Country:US
Mailing Address - Phone:989-624-4635
Mailing Address - Fax:
Practice Address - Street 1:12880 MORSEVILLE RD
Practice Address - Street 2:
Practice Address - City:BIRCH RUN
Practice Address - State:MI
Practice Address - Zip Code:48415-8787
Practice Address - Country:US
Practice Address - Phone:989-624-4635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-22
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502003869225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant