Provider Demographics
NPI:1912000373
Name:STONEY BATTER PHYSICAL THERAPY & SPINE CENTER, LLC
Entity Type:Organization
Organization Name:STONEY BATTER PHYSICAL THERAPY & SPINE CENTER, LLC
Other - Org Name:PHYSICAL THERAPY SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT / OWNER
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, CERT MDT
Authorized Official - Phone:302-234-8170
Mailing Address - Street 1:5307 LIMESTONE RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-1268
Mailing Address - Country:US
Mailing Address - Phone:302-234-8170
Mailing Address - Fax:302-234-8174
Practice Address - Street 1:5307 LIMESTONE RD
Practice Address - Street 2:SUITE 203
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-1268
Practice Address - Country:US
Practice Address - Phone:302-234-8170
Practice Address - Fax:302-234-8174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE1997115418174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G00897Medicare PIN
G00897Medicare PIN