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NPI Code Detail

MEDICARE: MRS. JACLYN WOOTERS PETUYA DPT

MEDICARE: MRS. JACLYN WOOTERS PETUYA DPT
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
1225100000XPhysical TherapistJ1-0003076DE

General Provider Information

NPI Number : 1669842100
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JACLYN WOOTERS PETUYA DPT
Provider Business Mailing Address
First Line : 23 FOREST CREEK DR
Second Line :
City : HOCKESSIN
State : DE
Zip : 19707-2017
Country : US
Telephone Number : 302-540-7006
Fax Number :
Provider Business Practice Location Address
First Line : 23 FOREST CREEK DR
Second Line :
City : HOCKESSIN
State : DE
Zip : 19707-2017
Country : US
Telephone Number : 302-540-7006
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/27/2015
Last Update Date : 12/30/2021

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