Provider Demographics
NPI:1831102888
Name:WEST MILFORD PHYSICAL THERAPY CENTER, LLC
Entity Type:Organization
Organization Name:WEST MILFORD PHYSICAL THERAPY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / OPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:F
Authorized Official - Last Name:KANE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:973-728-5588
Mailing Address - Street 1:2024 MACOPIN RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:WEST MILFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07480-1900
Mailing Address - Country:US
Mailing Address - Phone:973-728-5588
Mailing Address - Fax:973-728-0928
Practice Address - Street 1:2024 MACOPIN RD
Practice Address - Street 2:SUITE E
Practice Address - City:WEST MILFORD
Practice Address - State:NJ
Practice Address - Zip Code:07480-1900
Practice Address - Country:US
Practice Address - Phone:973-728-5588
Practice Address - Fax:973-728-0928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00411000225100000X
NJ40QA00411100225100000X
NJQA01121225100000X
NJQA02639225100000X
NJCO1517278751622225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ086428QXCMedicare ID - Type UnspecifiedTERENCE MORAN, DPT
NJ683833QXCMedicare ID - Type UnspecifiedANNE F KANE
NJ086422QXCMedicare ID - Type UnspecifiedMARYCLAIRE FLEMING-REILLY
NJ097147QXCMedicare ID - Type UnspecifiedSUSAN X. CAGNEY, OT
NJ845532QXCMedicare ID - Type UnspecifiedSEAN T KANE, PT