MEDICARE: WELLCARE PHYSICAL 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	225100000X	Physical Therapist	40QA00697400	NJ

General Provider Information

NPI Number	:	1790070365
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLCARE PHYSICAL THERAPY, LLC

Provider Business Mailing Address
First Line	:	16 WALNUT ST
Second Line	:
City	:	DUMONT
State	:	NJ
Zip	:	07628-2222
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3000 HADLEY RD
Second Line	:
City	:	SOUTH PLAINFIELD
State	:	NJ
Zip	:	07080-1183
Country	:	US
Telephone Number	:	201-220-5269
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. JINHEE CHOI
Credential	:	P.T.
Telephone Number	:	201-220-5269

Provider Enumeration Date	:	06/12/2011
Last Update Date	:	06/12/2011

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