Provider Demographics
NPI:1083722441
Name:WELLER, AMY E (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:E
Last Name:WELLER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 BROWN CT
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:08801-3409
Mailing Address - Country:US
Mailing Address - Phone:908-730-9110
Mailing Address - Fax:
Practice Address - Street 1:1 EAST ST
Practice Address - Street 2:SUITE 100
Practice Address - City:ANNANDALE
Practice Address - State:NJ
Practice Address - Zip Code:08801-3075
Practice Address - Country:US
Practice Address - Phone:908-730-6640
Practice Address - Fax:908-730-0468
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00633900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ024979 M4CMedicare ID - Type UnspecifiedMEDICARE NUMBER