Healthcare Provider Details

I. General information

NPI: 1609864313
Provider Name (Legal Business Name): WILLIAM M. WEIS JR. P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 US HIGHWAY 22 SUITE I
GREEN BROOK NJ
08812-1700
US

IV. Provider business mailing address

9 WILPERT RD
BRIDGEWATER NJ
08807-4604
US

V. Phone/Fax

Practice location:
  • Phone: 732-752-4646
  • Fax: 732-752-7804
Mailing address:
  • Phone: 732-764-0382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA00112800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: