Basic Information
| Provider Information | |||||||||
| NPI: | 1679935134 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BELEN | ||||||||
| FirstName: | WILBUR | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1078 S STATE ST STE 1 | ||||||||
| Address2: | |||||||||
| City: | DOVER | ||||||||
| State: | DE | ||||||||
| PostalCode: | 199016925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026782397 | ||||||||
| FaxNumber: | 3026782399 | ||||||||
| Practice Location | |||||||||
| Address1: | 1078 S STATE ST STE 1 | ||||||||
| Address2: | |||||||||
| City: | DOVER | ||||||||
| State: | DE | ||||||||
| PostalCode: | 199016925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026782397 | ||||||||
| FaxNumber: | 3026782399 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2016 | ||||||||
| LastUpdateDate: | 03/24/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | J1-0003250 | DE | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.