Provider Demographics
NPI:1831229756
Name:RECORDS, JOHN WILLIAM (PT)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:WILLIAM
Last Name:RECORDS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2600 GLASGOW AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-4773
Mailing Address - Country:US
Mailing Address - Phone:302-836-8287
Mailing Address - Fax:302-836-5536
Practice Address - Street 1:2600 GLASGOW AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-4773
Practice Address - Country:US
Practice Address - Phone:302-836-8287
Practice Address - Fax:302-836-5536
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0000179225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist