Provider Demographics
NPI:1104199918
Name:WILLE PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:WILLE PHYSICAL THERAPY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STACI
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:862-266-0703
Mailing Address - Street 1:514 LAFAYETTE RD
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-3494
Mailing Address - Country:US
Mailing Address - Phone:973-940-0871
Mailing Address - Fax:973-940-0872
Practice Address - Street 1:514 LAFAYETTE RD
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-3494
Practice Address - Country:US
Practice Address - Phone:973-940-0871
Practice Address - Fax:973-940-0872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-10
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00586800261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy