Provider Demographics
NPI:1811359565
Name:WHOLE BODY WELLNESS PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:WHOLE BODY WELLNESS PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:YUCHIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:973-216-1679
Mailing Address - Street 1:139 SOUTH ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NEW PROVIDENCE
Mailing Address - State:NJ
Mailing Address - Zip Code:07974-1999
Mailing Address - Country:US
Mailing Address - Phone:908-361-1113
Mailing Address - Fax:
Practice Address - Street 1:139 SOUTH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:NEW PROVIDENCE
Practice Address - State:NJ
Practice Address - Zip Code:07974-1999
Practice Address - Country:US
Practice Address - Phone:908-361-1113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01273300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty