Provider Demographics
NPI:1184493900
Name:IBW PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:IBW PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ILYZA
Authorized Official - Middle Name:BRIENNE
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, CERT MDT
Authorized Official - Phone:304-685-4399
Mailing Address - Street 1:631 WINDFLOWER CT
Mailing Address - Street 2:
Mailing Address - City:MORGANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07751-1772
Mailing Address - Country:US
Mailing Address - Phone:304-685-4399
Mailing Address - Fax:
Practice Address - Street 1:631 WINDFLOWER CT
Practice Address - Street 2:
Practice Address - City:MORGANVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07751-1772
Practice Address - Country:US
Practice Address - Phone:304-685-4399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-20
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty