Provider Demographics
NPI:1942244850
Name:WASHINGTON, PAUL ALVAN (PT)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:ALVAN
Last Name:WASHINGTON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:MARCUS HOOK
Mailing Address - State:PA
Mailing Address - Zip Code:19061-4513
Mailing Address - Country:US
Mailing Address - Phone:610-859-8850
Mailing Address - Fax:610-859-7876
Practice Address - Street 1:1218 BEAVER BROOK PLAZA
Practice Address - Street 2:SUITE A
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-8632
Practice Address - Country:US
Practice Address - Phone:302-544-4388
Practice Address - Fax:302-544-4387
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0001576225100000X
PAPT015144225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001939973OtherPA BLUE SHIELD
PA1018770990002Medicaid
PA30070466OtherKEYSTONE MERCY
DE1942244850Medicaid
DE3746091000OtherIBC
DE000053568OtherDPCI
PA160066VLZMedicare PIN
DEG02348D06Medicare PIN
DE000053568OtherDPCI
PA001939973OtherPA BLUE SHIELD