Healthcare Provider Details

I. General information

NPI: 1245513464
Provider Name (Legal Business Name): KATHLEEN PATRICE HIDALGO PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2011
Last Update Date: 09/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

053 MCKINLY LAB
NEWARK DE
19716
US

IV. Provider business mailing address

304 HADLEY CT
HOCKESSIN DE
19707-9208
US

V. Phone/Fax

Practice location:
  • Phone: 302-831-8893
  • Fax:
Mailing address:
  • Phone: 302-494-8023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberJ1-0000588
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: