=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639032667
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FYZICAL DELAWARE NORTH LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/05/2025
-----------------------------------------------------
Last Update Date | 12/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3600 SILVERSIDE RD STE B
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19810-5100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-212-4778
-----------------------------------------------------
Fax | 302-203-9966
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3600 SILVERSIDE RD STE B
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19810-5100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-212-4778
-----------------------------------------------------
Fax | 302-203-9966
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | BRIAN GILBERT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 302-212-4778
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------