Provider Demographics
NPI:1053005744
Name:ROBERTS, NOAH RICHARD
Entity type:Individual
Prefix:
First Name:NOAH
Middle Name:RICHARD
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EAST PALESTINE
Mailing Address - State:OH
Mailing Address - Zip Code:44413-1845
Mailing Address - Country:US
Mailing Address - Phone:330-843-6682
Mailing Address - Fax:
Practice Address - Street 1:201 KIMBERLY LN
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:KY
Practice Address - Zip Code:41097-9458
Practice Address - Country:US
Practice Address - Phone:859-824-7803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH011859225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant