Provider Demographics
NPI:1255472668
Name:WAINWRIGHT, ROBERT W (PT)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:W
Last Name:WAINWRIGHT
Suffix:
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 1:645 OCEAN RD
Mailing Address - Street 2:
Mailing Address - City:PT PLEASANT
Mailing Address - State:NJ
Mailing Address - Zip Code:08742-4056
Mailing Address - Country:US
Mailing Address - Phone:732-714-1907
Mailing Address - Fax:
Practice Address - Street 1:645 OCEAN RD
Practice Address - Street 2:
Practice Address - City:PT PLEASANT
Practice Address - State:NJ
Practice Address - Zip Code:08742-4056
Practice Address - Country:US
Practice Address - Phone:732-714-1907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00090800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ132713Medicare PIN