Healthcare Provider Details

I. General information

NPI: 1659009819
Provider Name (Legal Business Name): PHYSICAL THERAPY, CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2022
Last Update Date: 08/15/2022
Certification Date: 08/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 FOULK RD STE 2D
WILMINGTON DE
19803-3733
US

IV. Provider business mailing address

12 PELHAM RD
WILMINGTON DE
19803-4133
US

V. Phone/Fax

Practice location:
  • Phone: 302-654-8142
  • Fax: 302-654-8143
Mailing address:
  • Phone: 302-654-8142
  • Fax: 302-654-8143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: SHAUN MOORE
Title or Position: OWNER
Credential: PT
Phone: 302-654-8142