Jennifer Roberts, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

5502003362 Issued in MI

Practice address

25311 Little Mack Ave Ste a
Saint Clair Shores, MI 48081-3301

Phone

(586) 771-4900

Fax

(586) 771-4993

NPI assigned

Aug 31, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1630368000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731024000000",
    "number": "1821766346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33900 HARPER AVE STE 104",
            "city": "CLINTON TWP",
            "state": "MI",
            "postal_code": "480354258",
            "telephone_number": "586-350-2644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25311 LITTLE MACK AVE STE A",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480813301",
            "telephone_number": "586-771-4900",
            "fax_number": "586-771-4993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "JENNIFER",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-31",
        "last_updated": "2024-11-08",
        "certification_date": "2024-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MI",
            "license": "5502003362",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alaina Rizarri-Mlynarek
• Nabil Kamal Rizk, M.D.
• Traci Rizzo, MSN, PMHNP-BC
• Patricia Roach
• Robert G Patrus DPM PC
• Kathryn J Roberts
• Rachel L Roberts, RD
• Jenna Robidou, PA
• Arelynnd Robinson
• Cassandra Denise Robinson, ATC

• Physical Therapy Assistant in Saint Clair Shores, MI
• Providers in Saint Clair Shores, MI by specialty
• Physical Therapy Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2024; 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.