Individual
ROBBIE BACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA,CLT
Contact information
Practice address
10 DEFIANCE RD, MALAGA, NJ 08328-4324
(856) 793-8662
Mailing address
10 DEFIANCE RD, MALAGA, NJ 08328-4324
(856) 793-8662
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
40QBOO283300
NJ
Other
Enumeration date
01/22/2015
Last updated
01/22/2015
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