Healthcare Provider Details

I. General information

NPI: 1538705488
Provider Name (Legal Business Name): MABCF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2019
Last Update Date: 08/29/2023
Certification Date: 08/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5502 S DUPONT HWY
DOVER DE
19901-6440
US

IV. Provider business mailing address

300 HALL PL
MILFORD DE
19963-1809
US

V. Phone/Fax

Practice location:
  • Phone: 302-725-5116
  • Fax: 302-258-1853
Mailing address:
  • Phone: 302-396-0473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: LEO FERNANDEZ
Title or Position: OWNER
Credential: DPT
Phone: 302-396-0473