Healthcare Provider Details

I. General information

NPI: 1235054503
Provider Name (Legal Business Name): JACKELINE FUENTES PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1941 LIMESTONE RD STE 209
WILMINGTON DE
19808-5400
US

IV. Provider business mailing address

2105 OAK ST
WILMINGTON DE
19808-4832
US

V. Phone/Fax

Practice location:
  • Phone: 302-668-1030
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: