Healthcare Provider Details

I. General information

NPI: 1619033784
Provider Name (Legal Business Name): PREMIER PHYSICAL THERAPY AND SPORTS PERFORMANCE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2006
Last Update Date: 09/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 CLEAVER FARM RD SUITE 400
MIDDLETOWN DE
19709-1630
US

IV. Provider business mailing address

200 CLEAVER FARM RD SUITE 400
MIDDLETOWN DE
19709-1630
US

V. Phone/Fax

Practice location:
  • Phone: 302-449-2048
  • Fax: 302-449-2047
Mailing address:
  • Phone: 302-449-2048
  • Fax: 302-449-2047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2006601908
License Number StateDE

VIII. Authorized Official

Name: MR. PATRICK R. WILLIAMS
Title or Position: MEMBER
Credential: PT
Phone: 302-449-2048