Provider Demographics
NPI:1811413628
Name:BROOK, ROBERT ERNEST JR (PT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ERNEST
Last Name:BROOK
Suffix:JR
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 1:538 MARITA ANN DR
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08225-1423
Mailing Address - Country:US
Mailing Address - Phone:215-805-8018
Mailing Address - Fax:
Practice Address - Street 1:199 NEW RD STE 47
Practice Address - Street 2:
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221-2025
Practice Address - Country:US
Practice Address - Phone:609-204-4639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-15
Last Update Date:2017-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01394300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist