Provider Demographics
NPI:1437989779
Name:ROBERTS, NOAH GRAY (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:NOAH
Middle Name:GRAY
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1265 N 125 W
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:IN
Mailing Address - Zip Code:46131-7116
Mailing Address - Country:US
Mailing Address - Phone:317-654-4448
Mailing Address - Fax:
Practice Address - Street 1:421 MILLER AVE
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-2903
Practice Address - Country:US
Practice Address - Phone:317-654-4448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA306295225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist