Active NPI
Brandon Roberts, DPT
- Physical Therapist
- Traverse City, MI
National Provider Identifier
1447779335
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 5501018361
- Practice address
- 4000 Eastern Sky Dr Ste 6
Traverse City, MI 49684-7351 - Phone
- (231) 932-9014
- NPI assigned
- Sep 12, 2017
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 5501018361 | MI | Primary |
Addresses
Primary practice location
4000 Eastern Sky Dr Ste 6
Traverse City, MI 49684-7351
Mailing address
4000 Eastern Sky Dr Ste 6
Traverse City, MI 49684-7351
Phone (231) 932-9014
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5501018361 | MI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1505174400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1447779335",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4000 EASTERN SKY DR STE 6",
"city": "TRAVERSE CITY",
"state": "MI",
"postal_code": "496847351",
"telephone_number": "231-932-9014"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4000 EASTERN SKY DR STE 6",
"city": "TRAVERSE CITY",
"state": "MI",
"postal_code": "496847351",
"telephone_number": "231-932-9014"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTS",
"first_name": "BRANDON",
"name_prefix": "Mr.",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-09-12",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MI",
"license": "5501018361",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Traverse City, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.