Provider Demographics
NPI:1992339956
Name:ROBERTS, ROMAN ALLEN (MT,CWT)
Entity type:Individual
Prefix:
First Name:ROMAN
Middle Name:ALLEN
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:MT,CWT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 N UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45042-3390
Mailing Address - Country:US
Mailing Address - Phone:513-594-0661
Mailing Address - Fax:
Practice Address - Street 1:1004 N UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45042-3390
Practice Address - Country:US
Practice Address - Phone:513-594-0661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-28
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.010732225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist