Provider Demographics
NPI:1619033784
Name:PREMIER PHYSICAL THERAPY AND SPORTS PERFORMANCE, LLC
Entity Type:Organization
Organization Name:PREMIER PHYSICAL THERAPY AND SPORTS PERFORMANCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:R
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:302-449-2048
Mailing Address - Street 1:200 CLEAVER FARM RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-1630
Mailing Address - Country:US
Mailing Address - Phone:302-449-2048
Mailing Address - Fax:302-449-2047
Practice Address - Street 1:200 CLEAVER FARM RD
Practice Address - Street 2:SUITE 400
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-1630
Practice Address - Country:US
Practice Address - Phone:302-449-2048
Practice Address - Fax:302-449-2047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-31
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE2006601908225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty