Provider Demographics
NPI:1497016539
Name:ANDERSON, ROBERT B III (DPT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:B
Last Name:ANDERSON
Suffix:III
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 WESTON ST
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-2845
Mailing Address - Country:US
Mailing Address - Phone:973-870-9241
Mailing Address - Fax:
Practice Address - Street 1:51 WESTON ST
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-2845
Practice Address - Country:US
Practice Address - Phone:973-870-9241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40AQ01365300225100000X
GAPT010564225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist