Provider Demographics
NPI:1699037861
Name:THE PRINCETON PHYSICAL THERAPY GROUP, PC
Entity Type:Organization
Organization Name:THE PRINCETON PHYSICAL THERAPY GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:973-928-6969
Mailing Address - Street 1:2 BRIGHTON RD
Mailing Address - Street 2:SUITE 406
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07012-1663
Mailing Address - Country:US
Mailing Address - Phone:973-928-6969
Mailing Address - Fax:
Practice Address - Street 1:2 BRIGHTON RD
Practice Address - Street 2:SUITE 406
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07012-1663
Practice Address - Country:US
Practice Address - Phone:973-928-6969
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00876900261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy