Provider Demographics
NPI:1962244590
Name:ROBA, ENTELA (PT/DPT, LMT)
Entity type:Individual
Prefix:
First Name:ENTELA
Middle Name:
Last Name:ROBA
Suffix:
Gender:F
Credentials:PT/DPT, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 VENUS DR
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-1013
Mailing Address - Country:US
Mailing Address - Phone:508-579-0515
Mailing Address - Fax:
Practice Address - Street 1:19 VENUS DR
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-1013
Practice Address - Country:US
Practice Address - Phone:508-579-0515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-12
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA23853225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist