Provider Demographics
NPI:1225279326
Name:HOME-BASED PHYSICAL THERAPY
Entity type:Organization
Organization Name:HOME-BASED PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:LUCCA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, PHD, GCS
Authorized Official - Phone:302-750-1258
Mailing Address - Street 1:2806 BAYNARD BLVD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19802-2968
Mailing Address - Country:US
Mailing Address - Phone:302-750-1258
Mailing Address - Fax:302-831-4234
Practice Address - Street 1:2806 BAYNARD BLVD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19802-2968
Practice Address - Country:US
Practice Address - Phone:302-750-1258
Practice Address - Fax:302-831-4234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-19
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0000148261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
119977Medicare PIN