Active NPI
David Steven Roberts, PT
- Physical Therapist
- New London, MN
National Provider Identifier
1639263270
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 1677
- Practice address
- 7900 Chapin Dr NE
Allergy, Asthma and Dermatology Clinic
New London, MN 56273 - Phone
- (320) 354-4199
- NPI assigned
- Oct 3, 2006
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 4398-024 | WI | |
| Physical Therapist | 225100000X | 1677 | MN | Primary |
Addresses
Primary practice location
7900 Chapin Dr NE
Allergy, Asthma and Dermatology Clinic
New London, MN 56273
Mailing address
7900 Chapin Dr NE
Allergy, Asthma and Dermatology Clinic
New London, MN 56273
Phone (320) 354-4199
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 |
|---|---|---|---|
| 1677 | MN | MD | Mental Health Counselor |
| 4398-024 | WI | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pequot Lakes Physical Therapy Services, Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Physical Therapy Clinic/Center
- Pequot Lakes, MN
- NPI 1467589101
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159833600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1190332800000",
"number": "1639263270",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7900 CHAPIN DR NE",
"address_2": "ALLERGY, ASTHMA AND DERMATOLOGY CLINIC",
"city": "NEW LONDON",
"state": "MN",
"postal_code": "56273",
"telephone_number": "320-354-4199"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7900 CHAPIN DR NE",
"address_2": "ALLERGY, ASTHMA AND DERMATOLOGY CLINIC",
"city": "NEW LONDON",
"state": "MN",
"postal_code": "56273",
"telephone_number": "320-354-4199"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTS",
"first_name": "DAVID",
"middle_name": "STEVEN",
"name_prefix": "Mr.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-03",
"last_updated": "2007-09-21",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WI",
"license": "4398-024",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MN",
"license": "1677",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New London, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.