Provider Demographics
NPI:1184224040
Name:MCARDLE, ROBERT ALAN (PT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ALAN
Last Name:MCARDLE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28100 TORCH PKWY STE 600
Mailing Address - Street 2:
Mailing Address - City:WARRENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60555-4030
Mailing Address - Country:US
Mailing Address - Phone:630-413-5800
Mailing Address - Fax:
Practice Address - Street 1:MADONNA MANOR SKILLED NURSING FACILITY
Practice Address - Street 2:85 N WASHINGTON ST
Practice Address - City:N ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02760-6258
Practice Address - Country:US
Practice Address - Phone:508-699-2740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT00462225100000X
225100000X
MAPT8594225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist