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General NPI Number Information
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NPI Number | 1659009819
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Entity Type | Organization
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Legal Business Name | PHYSICAL THERAPY, CORP.
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Dates
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Enumeration Date | 08/15/2022
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Last Update Date | 08/15/2022
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Provider Practice Location Address
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Address Line | 701 FOULK RD STE 2D
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City | WILMINGTON
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State | DE
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Zip | 19803-3733
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Country | US
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Telephone | 302-654-8142
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Fax | 302-654-8143
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Provider Business Mailing Address
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Address Line | 12 PELHAM RD
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City | WILMINGTON
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State | DE
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Zip | 19803-4133
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Country | US
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Telephone | 302-654-8142
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Fax | 302-654-8143
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Authorized Official
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Title or Position | OWNER
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Name | SHAUN MOORE
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Credential | PT
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Telephone | 302-654-8142
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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 |
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License Number State |
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