Provider Demographics
NPI:1982657136
Name:STUCKERT, JOHN GEORGE JR (PT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:GEORGE
Last Name:STUCKERT
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:282 ECHELON RD
Mailing Address - Street 2:APT #6
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-2402
Mailing Address - Country:US
Mailing Address - Phone:856-701-8765
Mailing Address - Fax:856-566-1331
Practice Address - Street 1:1765 SPRINGDALE RD
Practice Address - Street 2:BUILDING A
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2177
Practice Address - Country:US
Practice Address - Phone:856-751-8787
Practice Address - Fax:856-751-0449
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ40QA00555700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist