Provider Demographics
NPI:1447314455
Name:SCANLON, ROBERT T (PT)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:T
Last Name:SCANLON
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 1:9 ROSALYN DR
Mailing Address - Street 2:
Mailing Address - City:LONG VALLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07853-3589
Mailing Address - Country:US
Mailing Address - Phone:908-687-1830
Mailing Address - Fax:
Practice Address - Street 1:47 MAPLE ST
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-2571
Practice Address - Country:US
Practice Address - Phone:908-598-9009
Practice Address - Fax:908-598-9492
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00283600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ025245M47Medicare ID - Type Unspecified