Provider Demographics
NPI: | 1811930282 |
---|---|
Name: | ROBINSON, RONALD CHRISTOPHER (PT, DPT) |
Entity type: | Individual |
Prefix: | |
First Name: | RONALD |
Middle Name: | CHRISTOPHER |
Last Name: | ROBINSON |
Suffix: | |
Gender: | M |
Credentials: | PT, DPT |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 224 STRAWBRIDGE DR STE 100 |
Mailing Address - Street 2: | |
Mailing Address - City: | MOORESTOWN |
Mailing Address - State: | NJ |
Mailing Address - Zip Code: | 08057-4602 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 856-677-4000 |
Mailing Address - Fax: | 856-234-3014 |
Practice Address - Street 1: | 23659 COLUMBUS RD STE 3 |
Practice Address - Street 2: | |
Practice Address - City: | COLUMBUS |
Practice Address - State: | NJ |
Practice Address - Zip Code: | 08022-1980 |
Practice Address - Country: | US |
Practice Address - Phone: | 609-416-3400 |
Practice Address - Fax: | 609-379-6858 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-06-14 |
Last Update Date: | 2021-05-27 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NJ | 40QA01100600 | 174400000X, 225100000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | |
No | 174400000X | Other Service Providers | Specialist |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NJ | 40QA01100600 | Other | NJ PT LICENSE |