Individual provider Active NPI

Dennis Roberge

  • Physical Therapist
  • Jacksonville, FL
National Provider Identifier
1770268633
Registry record updated Jun 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
13832 Issued in FL
Practice address
806 Briarcreek Rd
Jacksonville, FL 32225-5306
Phone
(860) 212-5849
NPI assigned
Jun 19, 2023
Last updated
Jun 19, 2023By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 19, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 13832 FL Primary

Addresses

Primary practice location

806 Briarcreek Rd
Jacksonville, FL 32225-5306

Mailing address

806 Briarcreek Rd
Jacksonville, FL 32225-5306
Phone (860) 212-5849

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

LicenseStateTypeSpecialty
13832FLMDPhysical Therapist

NPI Registry JSON

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

{
    "created_epoch": "1687132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687132800000",
    "number": "1770268633",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "806 BRIARCREEK RD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322255306",
            "telephone_number": "860-212-5849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "806 BRIARCREEK RD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322255306",
            "telephone_number": "860-212-5849"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERGE",
        "first_name": "DENNIS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-06-19",
        "last_updated": "2023-06-19",
        "certification_date": "2023-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "13832",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2023; 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.