Provider Demographics
NPI:1710098538
Name:WILLINGMYRE, MERYL A (PT)
Entity Type:Individual
Prefix:MRS
First Name:MERYL
Middle Name:A
Last Name:WILLINGMYRE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:MERYL
Other - Middle Name:A
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:4 FIR COURT
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081
Mailing Address - Country:US
Mailing Address - Phone:856-227-3005
Mailing Address - Fax:856-912-0477
Practice Address - Street 1:502/503 INDEPENDENCE BLVD. LAKESIDE BUSINESS PARK
Practice Address - Street 2:HEARLAND REHABILITATION SERVICES OF NEW JERSEY, INC
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081
Practice Address - Country:US
Practice Address - Phone:856-629-8777
Practice Address - Fax:856-629-8771
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01006900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist