Provider Demographics
NPI:1467404939
Name:MLKVY, ROBERT DAVID JR (MSPT)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:DAVID
Last Name:MLKVY
Suffix:JR
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 RUTGERS BLVD
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08009-7199
Mailing Address - Country:US
Mailing Address - Phone:856-809-1074
Mailing Address - Fax:
Practice Address - Street 1:501 5TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:ATCO
Practice Address - State:NJ
Practice Address - Zip Code:08004-1861
Practice Address - Country:US
Practice Address - Phone:856-768-3811
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01062900225100000X
PAPT008288L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist