MEDICARE: MR. TIMOTHY EUGENE VANDYKE PHYSICAL THERAPIST A

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	225200000X	Physical Therapy Assistant	40QB00201100	NJ

General Provider Information

NPI Number	:	1316972243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TIMOTHY EUGENE VANDYKE PHYSICAL THERAPIST A

Provider Business Mailing Address
First Line	:	300A PRINCETON HIGHTSTOWN RD
Second Line	:	STE 201
City	:	EAST WINDSOR
State	:	NJ
Zip	:	08520-1411
Country	:	US
Telephone Number	:	609-426-4442
Fax Number	:	609-443-0910

Provider Business Practice Location Address
First Line	:	300 PRINCETON HIGHTSTOWN ROAD
Second Line	:	BUILDING A STE 201
City	:	EAST WINDSOR
State	:	NJ
Zip	:	08520-1411
Country	:	US
Telephone Number	:	609-426-4442
Fax Number	:	609-443-0910

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	07/08/2007

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