Healthcare Provider Details

I. General information

NPI: 1306009394
Provider Name (Legal Business Name): REHAB BY DR LIFRAK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 07/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 N UNION ST SUITE 5
WILMINGTON DE
19805-2731
US

IV. Provider business mailing address

1010 N UNION ST SUITE 5
WILMINGTON DE
19805-2731
US

V. Phone/Fax

Practice location:
  • Phone: 302-654-7317
  • Fax:
Mailing address:
  • Phone: 302-654-7317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberC100002238
License Number StateDE

VIII. Authorized Official

Name: DR. JAMES SHEEHAN
Title or Position: CONTRACTOR
Credential: DC
Phone: 302-654-7317