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General NPI Number Information
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NPI Number | 1417115049
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Entity Type | Organization
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Legal Business Name | PENINSULA REHABILITATION AND SPORTS MEDICINE, INC.
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Dates
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Enumeration Date | 05/30/2008
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Last Update Date | 05/30/2008
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Provider Practice Location Address
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Address Line | 18958 COASTAL HWY STE A
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City | REHOBOTH BEACH
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State | DE
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Zip | 19971-6196
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Country | US
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Telephone | 302-645-9797
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Fax | 302-645-0411
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Provider Business Mailing Address
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Address Line | 18958 COASTAL HWY STE A
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City | REHOBOTH BEACH
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State | DE
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Zip | 19971-6196
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Country | US
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Telephone | 302-645-9797
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Fax | 302-645-0411
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MS. LESLEY K. ROGAN
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Credential | M.ED., PT, ATC
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Telephone | 302-645-9797
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | J1-0002288
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License Number State | DE
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | J1-0001325
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License Number State | DE
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | J1-0000810
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License Number State | DE
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