Provider Demographics
NPI:1194805705
Name:LINDELL PHYSICAL THERAPY OF DELAWARE PA
Entity type:Organization
Organization Name:LINDELL PHYSICAL THERAPY OF DELAWARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:STUART
Authorized Official - Last Name:KOGON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:302-998-7572
Mailing Address - Street 1:3300 CONCORD PIKE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-5028
Mailing Address - Country:US
Mailing Address - Phone:302-753-2700
Mailing Address - Fax:302-478-1975
Practice Address - Street 1:3300 CONCORD PIKE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-5028
Practice Address - Country:US
Practice Address - Phone:302-753-2700
Practice Address - Fax:302-478-1975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE1989030935225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE222340196OtherBCBS
DE282041OtherMAMSI
DE57287OtherAETNA
DEG00338Medicare ID - Type Unspecified