Healthcare Provider Details

I. General information

NPI: 1407078546
Provider Name (Legal Business Name): JEFFREY WEST DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 07/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38069 TOWN CENTER DR UNIT 15
MILLVILLE DE
19967-6968
US

IV. Provider business mailing address

106 MILFORD ST STE 601
SALISBURY MD
21804-6938
US

V. Phone/Fax

Practice location:
  • Phone: 302-539-3110
  • Fax: 302-539-7237
Mailing address:
  • Phone: 410-548-7600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberJ1-0002207
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: