Provider Demographics
NPI:1609334762
Name:WILMINGTON PHYSICAL MEDICINE AND REHABILITATION, INC.
Entity Type:Organization
Organization Name:WILMINGTON PHYSICAL MEDICINE AND REHABILITATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:KRISTOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-657-9393
Mailing Address - Street 1:600 LOUIS DR STE 202
Mailing Address - Street 2:
Mailing Address - City:WARMINSTER
Mailing Address - State:PA
Mailing Address - Zip Code:18974-2847
Mailing Address - Country:US
Mailing Address - Phone:215-957-5400
Mailing Address - Fax:215-957-5401
Practice Address - Street 1:104 SLEEPY HOLLOW DR STE 205
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-5842
Practice Address - Country:US
Practice Address - Phone:215-486-1800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-07
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2788078OtherBLUE CROSS