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General NPI Number Information
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NPI Number | 1619033784
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Entity Type | Organization
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Legal Business Name | PREMIER PHYSICAL THERAPY AND SPORTS PERFORMANCE, LLC
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Dates
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Enumeration Date | 12/31/2006
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Last Update Date | 09/07/2011
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Provider Practice Location Address
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Address Line | 200 CLEAVER FARM RD SUITE 400
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City | MIDDLETOWN
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State | DE
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Zip | 19709-1630
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Country | US
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Telephone | 302-449-2048
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Fax | 302-449-2047
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Provider Business Mailing Address
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Address Line | 200 CLEAVER FARM RD SUITE 400
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City | MIDDLETOWN
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State | DE
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Zip | 19709-1630
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Country | US
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Telephone | 302-449-2048
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Fax | 302-449-2047
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Authorized Official
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Title or Position | MEMBER
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Name | MR. PATRICK R. WILLIAMS
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Credential | PT
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Telephone | 302-449-2048
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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 | 2006601908
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License Number State | DE
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