Provider Demographics
NPI:1689048167
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:COO
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:BAYZICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-957-5400
Mailing Address - Street 1:WILMINGTON PHYSICAL AND REHABILITATION INC
Mailing Address - Street 2:600 LOUIS DRIVE SUITE 202
Mailing Address - City:WARMINSTER
Mailing Address - State:PA
Mailing Address - Zip Code:18974
Mailing Address - Country:US
Mailing Address - Phone:215-957-5400
Mailing Address - Fax:215-957-5401
Practice Address - Street 1:104 SLEEPY HOLLOW DRIVE SUITE 205
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19709
Practice Address - Country:US
Practice Address - Phone:215-601-6556
Practice Address - Fax:215-657-9398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-20
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEU57326Medicare UPIN
DEG01932B01Medicare PIN