Provider Demographics
NPI:1851353304
Name:MKL LTD LLC
Entity Type:Organization
Organization Name:MKL LTD LLC
Other - Org Name:CHRISTIANA PHYSICAL THERAPY & SPINE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:J
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:HANLING
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:302-731-2660
Mailing Address - Street 1:20 PEDDLERS VILLAGE CTR
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANA
Mailing Address - State:DE
Mailing Address - Zip Code:19702-1525
Mailing Address - Country:US
Mailing Address - Phone:302-731-2660
Mailing Address - Fax:302-731-2664
Practice Address - Street 1:20 PEDDLERS VILLAGE CTR
Practice Address - Street 2:
Practice Address - City:CHRISTIANA
Practice Address - State:DE
Practice Address - Zip Code:19702-1525
Practice Address - Country:US
Practice Address - Phone:302-731-2660
Practice Address - Fax:302-731-2664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE1997115418225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE=========OtherGROUP ID
DEG00897Medicare ID - Type UnspecifiedGROUP ID