Provider Demographics
NPI:1235370552
Name:SPORTSCARE & REHAB MANAGEMENT, LLC
Entity Type:Organization
Organization Name:SPORTSCARE & REHAB MANAGEMENT, LLC
Other - Org Name:PIKE CREEK PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITESEL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:302-239-2800
Mailing Address - Street 1:216 LANTANA DR
Mailing Address - Street 2:
Mailing Address - City:HOCKESSIN
Mailing Address - State:DE
Mailing Address - Zip Code:19707-8805
Mailing Address - Country:US
Mailing Address - Phone:302-239-2800
Mailing Address - Fax:302-239-7500
Practice Address - Street 1:3105 LIMESTONE RD STE 100
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-2147
Practice Address - Country:US
Practice Address - Phone:302-239-2800
Practice Address - Fax:302-239-7500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-17
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0000360225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty