MEDICARE: MR. KEVIN ELLIOT DUHADAWAY P.T.

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
1	208100000X	Physical Medicine & Rehabilitation Physician	JI-0000187	DE

General Provider Information

NPI Number	:	1922151364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KEVIN ELLIOT DUHADAWAY P.T.

Provider Business Mailing Address
First Line	:	202 MURPHY RD
Second Line	:
City	:	WILMINGTON
State	:	DE
Zip	:	19803-3129
Country	:	US
Telephone Number	:	302-888-0333
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 PHILADELPHIA PIKE
Second Line	:
City	:	WILMINGTON
State	:	DE
Zip	:	19809-1856
Country	:	US
Telephone Number	:	302-798-9565
Fax Number	:	302-798-0792

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	07/08/2007

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