Active NPI
Lonnie Perry Roberts III
- Athletic Trainer
- Dallas, TX
National Provider Identifier
1043038409
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- AT10109
- Practice address
- 100 S Glasgow Dr
Dallas, TX 75214-4518 - Phone
- (843) 731-4101
- NPI assigned
- Oct 2, 2024
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | AT10109 | TX | Primary |
Addresses
Primary practice location
100 S Glasgow Dr
Dallas, TX 75214-4518
Mailing address
1641 Lake Wateree Dr
Florence, SC 29501-8153
Phone (843) 731-4101
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AT10109 | TX | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1727827200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1768953600000",
"number": "1043038409",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1641 LAKE WATEREE DR",
"city": "FLORENCE",
"state": "SC",
"postal_code": "295018153",
"telephone_number": "843-731-4101"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 S GLASGOW DR",
"city": "DALLAS",
"state": "TX",
"postal_code": "752144518",
"telephone_number": "843-731-4101"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTS",
"first_name": "LONNIE",
"middle_name": "PERRY",
"name_suffix": "III",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-10-02",
"last_updated": "2026-01-21",
"certification_date": "2026-01-21",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "TX",
"license": "AT10109",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.