Healthcare Provider Details

I. General information

NPI: 1316977739
Provider Name (Legal Business Name): ROBERT DAVIS PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 02/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 GREENBROOK RD
NORTH PLAINFIELD NJ
07060-4560
US

IV. Provider business mailing address

50 GREENBROOK RD
NORTH PLAINFIELD NJ
07060-4560
US

V. Phone/Fax

Practice location:
  • Phone: 908-755-2111
  • Fax: 908-755-0614
Mailing address:
  • Phone: 908-755-2111
  • Fax: 908-755-0614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberQA 02972
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: