Molly Brucker, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

40QA01740300 Issued in NJ

Practice address

80 Mill St Ste 1
Newton, NJ 07860-1411

Phone

(973) 940-7311

Fax

(973) 940-7342

NPI assigned

Aug 27, 2017

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Molly Cornelissen Former name

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ivyrehab Network IncGroup PAC ID 3476539776, 658 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ivyrehab Network Inc.

  • Physical Therapist
  • Hoboken, NJ
  • NPI 1174577274
  Medicare reassignment Care Compare group NPD
• Ivyrehab Network, Inc.

  • Physical Medicine & Rehabilitation Physician
  • Cranford, NJ
  • NPI 1699590265

  Physical Therapist

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1503792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707264000000",
    "number": "1699292961",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 416495",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022416495",
            "telephone_number": "631-580-5200",
            "fax_number": "631-580-5222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 MILL ST STE 1",
            "city": "NEWTON",
            "state": "NJ",
            "postal_code": "078601411",
            "telephone_number": "973-940-7311",
            "fax_number": "973-940-7342"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1314 19th Ave",
            "address_purpose": "LOCATION",
            "city": "Meridian",
            "state": "MS",
            "postal_code": "393014116",
            "country_code": "US",
            "telephone_number": "601-483-0011",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRUCKER",
        "first_name": "MOLLY",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-27",
        "last_updated": "2024-02-07",
        "certification_date": "2024-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MS",
            "license": "PT6280",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "40QA01740300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MOLLY",
            "last_name": "CORNELISSEN",
            "credential": "DPT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Broadstep Academy-New Jersey, Inc.
• David Samuel Brody, DMD
• Jessica Broesler, CPRS
• Dana Brogneri, PT, DPT
• Michelle Brown
• Josef Bruno
• Lydia Buchalski, LCSW, LCADC, ACS
• Karl Burkhardt, PHARMD
• David S Buyer, MD
• Michelle Marie Cahill, LPC

• Physical Therapist in Newton, NJ
• Providers in Newton, NJ by specialty
• Physical Therapist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.