Provider Demographics
NPI:1053490318
Name:WHALEN, JOSEPH (PT)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:WHALEN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 S WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19963-2336
Mailing Address - Country:US
Mailing Address - Phone:410-822-4613
Mailing Address - Fax:410-822-6534
Practice Address - Street 1:1 PEDDLERS VLG
Practice Address - Street 2:SUITE A1
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-9503
Practice Address - Country:US
Practice Address - Phone:410-822-4613
Practice Address - Fax:410-822-6534
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ10000278225100000X
MD16007225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000220726Medicaid
DE086513Medicare ID - Type Unspecified