Healthcare Provider Details

I. General information

NPI: 1467632018
Provider Name (Legal Business Name): EILEEN MASCHERINO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2007
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4709 KIRKWOOD HWY
WILMINGTON DE
19808-5007
US

IV. Provider business mailing address

2122 YORK RD STE 300
OAK BROOK IL
60523-1925
US

V. Phone/Fax

Practice location:
  • Phone: 302-998-9880
  • Fax: 302-998-7498
Mailing address:
  • Phone: 803-812-3656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTO18884
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberJ1-0001284
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: