Provider Demographics
NPI:1104824937
Name:B&W PHYSICAL THERAPY & ASSOCIATES
Entity Type:Organization
Organization Name:B&W PHYSICAL THERAPY & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:L
Authorized Official - Last Name:JOHNS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:610-562-0437
Mailing Address - Street 1:800 SHOEMAKER AVE
Mailing Address - Street 2:
Mailing Address - City:SHOEMAKERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19555-1635
Mailing Address - Country:US
Mailing Address - Phone:610-562-0437
Mailing Address - Fax:610-562-0522
Practice Address - Street 1:800 SHOEMAKER AVE
Practice Address - Street 2:
Practice Address - City:SHOEMAKERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19555-1635
Practice Address - Country:US
Practice Address - Phone:610-562-0437
Practice Address - Fax:610-562-0522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-14
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT000260-E225100000X
PAPT-012979-L225100000X
PATE000401L225200000X
PAPT012979L225200000X
PATE000736L225200000X
PAOC-000275-L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA39-6717Medicare ID - Type UnspecifiedPROVIDER NUMBER