Provider Demographics
NPI:1902950264
Name:STROUD, BRUCE JOHN ROY (PT)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:JOHN ROY
Last Name:STROUD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:BRUCE
Other - Middle Name:
Other - Last Name:STROUD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:4 SAXONY CT
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-8531
Mailing Address - Country:US
Mailing Address - Phone:609-257-3130
Mailing Address - Fax:
Practice Address - Street 1:200 TUCKERTON RD
Practice Address - Street 2:SUITE # 17
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-8806
Practice Address - Country:US
Practice Address - Phone:856-396-2250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00484600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist