Provider Demographics
NPI:1821086786
Name:FORMAN, MAGAN (PT)
Entity Type:Individual
Prefix:
First Name:MAGAN
Middle Name:
Last Name:FORMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 ORACLE RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-1562
Mailing Address - Country:US
Mailing Address - Phone:443-386-2365
Mailing Address - Fax:
Practice Address - Street 1:325 ORACLE RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-1562
Practice Address - Country:US
Practice Address - Phone:443-386-2365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20107225100000X
DEJ1-0014510225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDJ835Medicare ID - Type Unspecified