MEDICARE: JANICE PATRICIA WEINERT PHYSICAL THERAPIST

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	020482-1	NY

General Provider Information

NPI Number	:	1467755793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANICE PATRICIA WEINERT PHYSICAL THERAPIST

Provider Business Mailing Address
First Line	:	12411 NEWPORT AVE
Second Line	:
City	:	ROCKAWAY PARK
State	:	NY
Zip	:	11694-1740
Country	:	US
Telephone Number	:	718-945-4099
Fax Number	:

Provider Business Practice Location Address
First Line	:	12411 NEWPORT AVE
Second Line	:
City	:	ROCKAWAY PARK
State	:	NY
Zip	:	11694-1740
Country	:	US
Telephone Number	:	718-945-4099
Fax Number	:

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

Provider Enumeration Date	:	12/08/2010
Last Update Date	:	12/08/2010

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