Leo E Robertson III, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT-2026 Issued in ID

Practice address

134 S State St
Preston, ID 83263

Phone

(208) 852-4122

Fax

(208) 852-7187

NPI assigned

Apr 17, 2007

Last updated

Jul 5, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Franklin County Medical Center

  dba FCMC Developmental Disabilities Agency (For Children)

  • Developmentally Disabled Services Day Training Agency
  • Preston, ID
  • NPI 1871389585
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176768000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1530748800000",
    "number": "1346465887",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "44 N 1ST E",
            "city": "PRESTON",
            "state": "ID",
            "postal_code": "832631326",
            "telephone_number": "208-852-4122",
            "fax_number": "208-852-7187"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "134 S STATE ST",
            "city": "PRESTON",
            "state": "ID",
            "postal_code": "83263",
            "telephone_number": "208-852-4122",
            "fax_number": "208-852-7187"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2380 N 400 E",
            "address_purpose": "LOCATION",
            "city": "Logan",
            "state": "UT",
            "postal_code": "843411749",
            "country_code": "US",
            "telephone_number": "435-713-9700",
            "fax_number": "435-753-8005",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROBERTSON",
        "first_name": "LEO",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-17",
        "last_updated": "2018-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "ID",
            "license": "PT-2026",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1346465887",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "D5960",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICAL THERAPY LICENSE",
            "identifier": "PT-2026",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Preston, ID
• Providers in Preston, ID by specialty
• Physical Therapist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.