Provider Demographics
NPI:1205360583
Name:WOERNER, GARY (DPT)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:WOERNER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 W BRIGANTINE AVE
Mailing Address - Street 2:
Mailing Address - City:BRIGANTINE
Mailing Address - State:NJ
Mailing Address - Zip Code:08203-1609
Mailing Address - Country:US
Mailing Address - Phone:609-264-1666
Mailing Address - Fax:609-264-8393
Practice Address - Street 1:3201 W BRIGANTINE AVE
Practice Address - Street 2:
Practice Address - City:BRIGANTINE
Practice Address - State:NJ
Practice Address - Zip Code:08203-1609
Practice Address - Country:US
Practice Address - Phone:609-264-1666
Practice Address - Fax:609-264-8393
Is Sole Proprietor?:No
Enumeration Date:2017-04-13
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01833500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist