Provider Demographics
NPI:1700945219
Name:DAWKINS JR, RICHARD L (PT)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:L
Last Name:DAWKINS JR
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 1:990 CEDARBRIDGE AVE
Mailing Address - Street 2:B-16
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-4159
Mailing Address - Country:US
Mailing Address - Phone:732-262-0111
Mailing Address - Fax:732-262-0332
Practice Address - Street 1:990 CEDARBRIDGE AVE
Practice Address - Street 2:B-16
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-4159
Practice Address - Country:US
Practice Address - Phone:732-262-0111
Practice Address - Fax:732-262-0332
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00671000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ030494719OtherTAX ID NUMBER
NJ068083Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
NJ025584RKWMedicare ID - Type UnspecifiedINDIVIDUAL MDCR #