MEDICARE: THERAPHYSICAL, 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	:	1821694670
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THERAPHYSICAL, LLC

Provider Business Mailing Address
First Line	:	623 RIDGE RD
Second Line	:
City	:	LYNDHURST
State	:	NJ
Zip	:	07071-3205
Country	:	US
Telephone Number	:	201-340-4656
Fax Number	:

Provider Business Practice Location Address
First Line	:	118 OUTWATER LN
Second Line	:
City	:	GARFIELD
State	:	NJ
Zip	:	07026-2629
Country	:	US
Telephone Number	:	973-955-2190
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MAGDEALENA BUCZEK
Credential	:	DPT
Telephone Number	:	201-340-4656

Provider Enumeration Date	:	12/08/2020
Last Update Date	:	12/08/2020

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Directions to “THERAPHYSICAL, LLC ” Practice Location

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