Provider Demographics
NPI:1962443770
Name:MANLEY, ROBERT (MPT)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:MANLEY
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178 LAKEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-4071
Mailing Address - Country:US
Mailing Address - Phone:973-998-8828
Mailing Address - Fax:973-998-8830
Practice Address - Street 1:178 LAKEVIEW AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-4071
Practice Address - Country:US
Practice Address - Phone:973-998-8828
Practice Address - Fax:973-998-8830
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00949700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ096450Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER