Provider Demographics
NPI:1710194337
Name:DELAWARE THERAPEUTICS INC
Entity Type:Organization
Organization Name:DELAWARE THERAPEUTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CHUCK
Authorized Official - Middle Name:
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:302-836-6150
Mailing Address - Street 1:12 FOX HUNT DR
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-2534
Mailing Address - Country:US
Mailing Address - Phone:302-836-6150
Mailing Address - Fax:302-836-6294
Practice Address - Street 1:12 FOX HUNT DR
Practice Address - Street 2:
Practice Address - City:BEAR
Practice Address - State:DE
Practice Address - Zip Code:19701-2534
Practice Address - Country:US
Practice Address - Phone:302-836-6150
Practice Address - Fax:302-836-6294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE1999201447174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEMT-0001046OtherMASSAGE THERAPIST LICENSE