Healthcare Provider Details

I. General information

NPI: 1104283282
Provider Name (Legal Business Name): SCOTT D FENSTERMACHER PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2016
Last Update Date: 08/30/2023
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 S COLLEGE AVE SUITE 160
NEWARK DE
19713-1302
US

IV. Provider business mailing address

540 S COLLEGE AVE SUITE 160
NEWARK DE
19713-1302
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number05014405A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number05014405A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberJ1-0003440
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: