MEDICARE: WAYNE PHYSICAL THERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1073660247
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WAYNE PHYSICAL THERAPY LLC

Provider Business Mailing Address
First Line	:	PO BOX 600
Second Line	:
City	:	FAIR LAWN
State	:	NJ
Zip	:	07410-0600
Country	:	US
Telephone Number	:	201-794-2121
Fax Number	:	201-794-6003

Provider Business Practice Location Address
First Line	:	401 HAMBURG TPKE STE 102
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-2139
Country	:	US
Telephone Number	:	201-794-2121
Fax Number	:	201-794-6003

Authorized Official
Title or Position	:	TREASURER
Name	:	DR. WILLIAM F THIMMEL
Credential	:	DC
Telephone Number	:	201-794-3034

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	07/20/2007

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Directions to “WAYNE PHYSICAL THERAPY LLC ” Practice Location

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