MEDICARE: NORTHERN HILLS 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	261QP2000X	Physical Therapy Clinic/Center	40QA01253300	NJ

General Provider Information

NPI Number	:	1881839603
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHERN HILLS PHYSICAL THERAPY, LLC

Provider Business Mailing Address
First Line	:	272 ROUTE 206
Second Line	:	SUITE 210
City	:	FLANDERS
State	:	NJ
Zip	:	07836-9081
Country	:	US
Telephone Number	:	973-927-3034
Fax Number	:	973-927-2853

Provider Business Practice Location Address
First Line	:	272 ROUTE 206
Second Line	:	SUITE 210
City	:	FLANDERS
State	:	NJ
Zip	:	07836-9081
Country	:	US
Telephone Number	:	973-927-3034
Fax Number	:	973-927-2853

Authorized Official
Title or Position	:	OWNER
Name	:	DR. EILEEN CHRISTINE DECARO
Credential	:	DPT
Telephone Number	:	973-945-4160

Provider Enumeration Date	:	12/08/2008
Last Update Date	:	12/08/2008

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