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General NPI Number Information
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NPI Number | 1376035642
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Entity Type | Organization
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Legal Business Name | JW PHYSICAL THERAPY
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Dates
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Enumeration Date | 06/03/2018
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Last Update Date | 06/03/2018
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Provider Practice Location Address
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Address Line | 410 E AVE
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City | CORONADO
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State | CA
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Zip | 92118-1716
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Country | US
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Telephone | 609-658-9191
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Fax |
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Provider Business Mailing Address
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Address Line | 410 E AVE
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City | CORONADO
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State | CA
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Zip | 92118-1716
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER, PT, DPT
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Name | JENNIFER WAIDELICH
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Credential | DPT
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Telephone | 609-658-9191
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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