Healthcare Provider Details

I. General information

NPI: 1184832503
Provider Name (Legal Business Name): EILEEN M KANE PT, CHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 07/28/2021
Certification Date: 07/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 FORREST AVE STE 105A
DOVER DE
19904-3310
US

IV. Provider business mailing address

750 PRIDES XING STE 112
NEWARK DE
19713-6107
US

V. Phone/Fax

Practice location:
  • Phone: 302-268-8880
  • Fax: 302-278-0272
Mailing address:
  • Phone: 302-864-2222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01230700
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number9232PT
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT017843
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberJ1-0003672
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: