Provider Demographics
NPI:1073660247
Name:WAYNE PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:WAYNE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:F
Authorized Official - Last Name:THIMMEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-794-3034
Mailing Address - Street 1:PO BOX 600
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-0600
Mailing Address - Country:US
Mailing Address - Phone:201-794-2121
Mailing Address - Fax:201-794-6003
Practice Address - Street 1:401 HAMBURG TPKE STE 102
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2139
Practice Address - Country:US
Practice Address - Phone:201-794-2121
Practice Address - Fax:201-794-6003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty