Healthcare Provider Details

I. General information

NPI: 1720734502
Provider Name (Legal Business Name): ROBERT PAUL GLASS III DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2022
Last Update Date: 03/01/2022
Certification Date: 03/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 LAUREL RD
VOORHEES NJ
08043-2317
US

IV. Provider business mailing address

12 EDINBURGH RD
BLACKWOOD NJ
08012-4526
US

V. Phone/Fax

Practice location:
  • Phone: 856-772-9400
  • Fax:
Mailing address:
  • Phone: 856-905-7075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01620300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: