MEDICARE: IN REHABILITATION AND WELLNESS PC

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	40QA01140100	NJ

General Provider Information

NPI Number	:	1558383661
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IN REHABILITATION AND WELLNESS PC

Provider Business Mailing Address
First Line	:	464 HUDSON TER
Second Line	:	SUITE 204
City	:	ENGLEWOOD CLIFFS
State	:	NJ
Zip	:	07632-2902
Country	:	US
Telephone Number	:	201-894-5451
Fax Number	:	201-894-5450

Provider Business Practice Location Address
First Line	:	464 HUDSON TER
Second Line	:	SUITE 204
City	:	ENGLEWOOD CLIFFS
State	:	NJ
Zip	:	07632-2917
Country	:	US
Telephone Number	:	201-894-5451
Fax Number	:	201-894-5450

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	DAEGYUN KIM
Credential	:	P.T.
Telephone Number	:	201-894-5451

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	10/30/2008

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