Healthcare Provider Details

I. General information

NPI: 1366463010
Provider Name (Legal Business Name): MR. DYLAND PASCUAL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 02/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 OGLETOWN STANTON RD SUITE 4100
NEWARK DE
19713-2055
US

IV. Provider business mailing address

410 9TH ST
DANVILLE PA
17821-7682
US

V. Phone/Fax

Practice location:
  • Phone: 302-652-1181
  • Fax:
Mailing address:
  • Phone: 302-000-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberJ2-0000297
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberTE1000243
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: