Provider Demographics
NPI:1659307494
Name:WILLS, EDWIN SCOTT (PT)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:SCOTT
Last Name:WILLS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 BERKLEY CT
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2446
Mailing Address - Country:US
Mailing Address - Phone:973-389-8248
Mailing Address - Fax:
Practice Address - Street 1:465 ROUTE 23
Practice Address - Street 2:
Practice Address - City:POMPTON PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07444-1814
Practice Address - Country:US
Practice Address - Phone:973-513-9055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QAO352800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist