Provider Demographics
NPI:1720018849
Name:OUTSLAY, MERRILL DUNCAN (PT, ATC, CSCS)
Entity Type:Individual
Prefix:
First Name:MERRILL
Middle Name:DUNCAN
Last Name:OUTSLAY
Suffix:
Gender:M
Credentials:PT, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HYGEIA DR
Mailing Address - Street 2:SUITE 2300 / FINANCE DEPARTMENT
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2049
Mailing Address - Country:US
Mailing Address - Phone:302-623-7228
Mailing Address - Fax:302-623-7425
Practice Address - Street 1:5311 LIMESTONE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-1246
Practice Address - Country:US
Practice Address - Phone:302-235-4650
Practice Address - Fax:302-235-4659
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ10001569225100000X
DEJ300000382255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000035838Medicaid
DE016151C44Medicare PIN