Provider Demographics
NPI:1558248005
Name:ROBLE, DANIEL (PTA, L; ATC, LAT)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:ROBLE
Suffix:
Gender:M
Credentials:PTA, L; ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4718 MOUNT ROYAL LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-4689
Mailing Address - Country:US
Mailing Address - Phone:317-698-5260
Mailing Address - Fax:
Practice Address - Street 1:5935 CARNEGIE BLVD STE 104
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-4672
Practice Address - Country:US
Practice Address - Phone:704-323-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-18
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA4805225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant