Provider Demographics
NPI:1780687053
Name:HANLING, J MATTHEW (PT, CERT, MDT)
Entity type:Individual
Prefix:
First Name:J
Middle Name:MATTHEW
Last Name:HANLING
Suffix:
Gender:M
Credentials:PT, CERT, MDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5307 LIMESTONE ROAD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808
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
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ10000534225100000X
PAPT0052927L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DES53652OtherBCBS PROVIDER ID
DE5707453OtherAETNA PROVIDER ID
DE1000037609Medicaid
DE1000037609Medicaid