Healthcare Provider Details

I. General information

NPI: 1609334762
Provider Name (Legal Business Name): WILMINGTON PHYSICAL MEDICINE AND REHABILITATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2019
Last Update Date: 06/09/2022
Certification Date: 06/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 SLEEPY HOLLOW DR STE 205
MIDDLETOWN DE
19709-5842
US

IV. Provider business mailing address

600 LOUIS DR STE 202
WARMINSTER PA
18974-2847
US

V. Phone/Fax

Practice location:
  • Phone: 215-486-1800
  • Fax:
Mailing address:
  • Phone: 215-957-5400
  • Fax: 215-957-5401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: SHARON KRISTOFF
Title or Position: OFFICE MANAGER
Credential:
Phone: 215-657-9393