Provider Demographics
NPI:1528047156
Name:ROBERTS, MICHAEL ELVIN (ATC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ELVIN
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2725 S 144TH ST
Mailing Address - Street 2:STE 212
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-5243
Mailing Address - Country:US
Mailing Address - Phone:402-637-0668
Mailing Address - Fax:402-637-0808
Practice Address - Street 1:2725 S 144TH ST
Practice Address - Street 2:STE 212
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-5243
Practice Address - Country:US
Practice Address - Phone:402-637-0668
Practice Address - Fax:402-637-0808
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3162255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer