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General NPI Number Information
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NPI Number | 1699037861
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Entity Type | Organization
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Legal Business Name | THE PRINCETON PHYSICAL THERAPY GROUP, PC
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Dates
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Enumeration Date | 06/13/2012
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Last Update Date | 06/13/2012
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Provider Practice Location Address
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Address Line | 2 BRIGHTON RD SUITE 406
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City | CLIFTON
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State | NJ
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Zip | 07012-1663
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Country | US
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Telephone | 973-928-6969
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Fax |
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Provider Business Mailing Address
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Address Line | 2 BRIGHTON RD SUITE 406
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City | CLIFTON
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State | NJ
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Zip | 07012-1663
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Country | US
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Telephone | 973-928-6969
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ROBERT TUCKER
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Credential | MSPT
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Telephone | 973-928-6969
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 40QA00876900
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License Number State | NJ
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