Jennifer B. Wathne, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

40QB00310900 Issued in NJ

Practice address

540 Route 10 W
Randolph, NJ 07869-2026

Phone

(973) 366-6615

Fax

(973) 366-9427

NPI assigned

Sep 15, 2016

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1473897600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1473897600000",
    "number": "1467900712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "540 ROUTE 10 W",
            "city": "RANDOLPH",
            "state": "NJ",
            "postal_code": "078692026",
            "telephone_number": "973-366-6615",
            "fax_number": "973-366-9427"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "540 ROUTE 10 W",
            "city": "RANDOLPH",
            "state": "NJ",
            "postal_code": "078692026",
            "telephone_number": "973-366-6615",
            "fax_number": "973-366-9427"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATHNE",
        "first_name": "JENNIFER",
        "middle_name": "B.",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-09-15",
        "last_updated": "2016-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "NJ",
            "license": "40QB00310900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Richard Nathaniel Walker, D.O.
• Daniel Patrick Walsh, BSC, MSC
• Virginia Walsh, DMD
• Georgeann Walter, LCSW
• Alison Marie Ward, LMSW
• Abraham Wei
• Gail P Weinroth, LPC
• Bonnie Weiss, LCSW
• Welltower Opco Group LLC
• Danya J Wenzler, M.D.

• Physical Therapy Assistant in Randolph, NJ
• Providers in Randolph, NJ by specialty
• Physical Therapy Assistant in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.