Provider Demographics
NPI:1588948640
Name:ROBERTS, PATRICK D (BA, HIS)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:D
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:BA, HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 WHITE HILLS DR STE 400
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-5516
Mailing Address - Country:US
Mailing Address - Phone:972-961-7177
Mailing Address - Fax:972-722-7772
Practice Address - Street 1:601 WHITE HILLS DR STE 400
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-5516
Practice Address - Country:US
Practice Address - Phone:972-961-7177
Practice Address - Fax:972-722-7772
Is Sole Proprietor?:No
Enumeration Date:2011-10-06
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80461237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist