Provider Demographics
NPI:1912672593
Name:ROBERTS, SHAWN MICHAEL (PHYSICAL THERAPY)
Entity type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:MICHAEL
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:PHYSICAL THERAPY
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Mailing Address - Street 1:3968 GREENBUSH RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:VT
Mailing Address - Zip Code:05445-9306
Mailing Address - Country:US
Mailing Address - Phone:802-735-7511
Mailing Address - Fax:
Practice Address - Street 1:41 HITCHCOCK WAY
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-3174
Practice Address - Country:US
Practice Address - Phone:805-682-2536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-15
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VT040.0134263225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist