Healthcare Provider Details

I. General information

NPI: 1942630561
Provider Name (Legal Business Name): IAN GRIFFITH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2013
Last Update Date: 12/15/2021
Certification Date: 12/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 ATLANTIC AVE
OCEAN VIEW DE
19970-9155
US

IV. Provider business mailing address

33691 CANAL DRIVE
FRANKFORD DE
19945-2304
US

V. Phone/Fax

Practice location:
  • Phone: 302-541-5705
  • Fax:
Mailing address:
  • Phone: 484-459-2911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number24818
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberJ1-0003638
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: