Provider Demographics
NPI:1023043346
Name:PINKERTON, DAVID LEE (MPT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:LEE
Last Name:PINKERTON
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:213 E DUPONT HWY UNIT 1
Practice Address - Street 2:
Practice Address - City:MILLSBORO
Practice Address - State:DE
Practice Address - Zip Code:19966-1817
Practice Address - Country:US
Practice Address - Phone:302-297-0700
Practice Address - Fax:302-297-0701
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT9256225100000X
DEJ10002156225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2848238000OtherAMERIHEALTH/IBC
5070-0045OtherCARE FIRST
1023043346OtherCHAMPUS TRICARE
DE1023043346Medicaid
DEJ10002156OtherDE LICENSE
88760501OtherNCA
DE1023043346Medicaid