Healthcare Provider Details

I. General information

NPI: 1740736743
Provider Name (Legal Business Name): SOUTHERN DELAWARE SPORTSCARE AND REHABILITATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2016
Last Update Date: 08/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 S GOVERNORS AVE
DOVER DE
19904-6901
US

IV. Provider business mailing address

501 FAIRMOUNT AVE STE 302
TOWSON MD
21286-5457
US

V. Phone/Fax

Practice location:
  • Phone: 302-730-4800
  • Fax:
Mailing address:
  • Phone: 410-927-8768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: HARRIS THOMPSON
Title or Position: CEO
Credential:
Phone: 410-885-6371