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NPI Code Detail

MEDICARE: WILMINGTON PHYSICAL MEDICINE AND REHABILITATION, INC.

MEDICARE: WILMINGTON PHYSICAL MEDICINE AND REHABILITATION, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12081P2900XPain Medicine (Physical Medicine & Rehabilitation) Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12788078OTHERPABLUE CROSS

General Provider Information

NPI Number : 1609334762
Entity Type Code : Organization
Provider Name (Legal Business Name) : WILMINGTON PHYSICAL MEDICINE AND REHABILITATION, INC.
Provider Business Mailing Address
First Line : 600 LOUIS DR STE 202
Second Line :
City : WARMINSTER
State : PA
Zip : 18974-2847
Country : US
Telephone Number : 215-957-5400
Fax Number : 215-957-5401
Provider Business Practice Location Address
First Line : 104 SLEEPY HOLLOW DR STE 205
Second Line :
City : MIDDLETOWN
State : DE
Zip : 19709-5842
Country : US
Telephone Number : 215-486-1800
Fax Number :
Authorized Official
Title or Position : OFFICE MANAGER
Name : SHARON KRISTOFF
Credential :
Telephone Number : 215-657-9393
Provider Enumeration Date : 03/07/2019
Last Update Date : 06/09/2022

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