Provider Demographics
NPI:1245282755
Name:TUCKER, ROBERT L (MSPT)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:TUCKER
Suffix:
Gender:
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 BURNETT PL
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-2401
Mailing Address - Country:US
Mailing Address - Phone:201-491-8400
Mailing Address - Fax:201-491-9400
Practice Address - Street 1:6 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:MONTVALE
Practice Address - State:NJ
Practice Address - Zip Code:07645-2111
Practice Address - Country:US
Practice Address - Phone:201-491-8400
Practice Address - Fax:201-491-9400
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00876900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ069448Medicare ID - Type Unspecified
NJP88496Medicare UPIN