MEDICARE: INSTITUTE OF MANUAL 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	208100000X	Physical Medicine & Rehabilitation Physician	40QA00730700	NJ

General Provider Information

NPI Number	:	1235427113
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INSTITUTE OF MANUAL THERAPY LLC

Provider Business Mailing Address
First Line	:	780 RT 37 WEST
Second Line	:	SUITE 210
City	:	TOMS RIVER
State	:	NJ
Zip	:	08755-5059
Country	:	US
Telephone Number	:	732-736-7007
Fax Number	:	732-736-7009

Provider Business Practice Location Address
First Line	:	780 RT 37 WEST
Second Line	:	SUITE 210
City	:	TOMS RIVER
State	:	NJ
Zip	:	08755-5059
Country	:	US
Telephone Number	:	732-736-7007
Fax Number	:	732-736-7009

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KENNETH PAVLINEC
Credential	:	PT
Telephone Number	:	732-736-7007

Provider Enumeration Date	:	07/13/2011
Last Update Date	:	07/13/2011

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