Healthcare Provider Details

I. General information

NPI: 1225279326
Provider Name (Legal Business Name): HOME-BASED PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2009
Last Update Date: 08/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2806 BAYNARD BLVD
WILMINGTON DE
19802-2968
US

IV. Provider business mailing address

2806 BAYNARD BLVD
WILMINGTON DE
19802-2968
US

V. Phone/Fax

Practice location:
  • Phone: 302-750-1258
  • Fax: 302-831-4234
Mailing address:
  • Phone: 302-750-1258
  • Fax: 302-831-4234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberJ1-0000148
License Number StateDE

VIII. Authorized Official

Name: DR. JOSEPH A LUCCA
Title or Position: OWNER
Credential: DPT, PHD, GCS
Phone: 302-750-1258