Basic Information
| Provider Information | |||||||||
| NPI: | 1942244850 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WASHINGTON | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | ALVAN | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 W 10TH ST | ||||||||
| Address2: | |||||||||
| City: | MARCUS HOOK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190614513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108598850 | ||||||||
| FaxNumber: | 6108597876 | ||||||||
| Practice Location | |||||||||
| Address1: | 1218 BEAVER BROOK PLAZA | ||||||||
| Address2: | SUITE A | ||||||||
| City: | NEW CASTLE | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197208632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3025444388 | ||||||||
| FaxNumber: | 3025444387 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2006 | ||||||||
| LastUpdateDate: | 06/13/2011 | ||||||||
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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 | J1-0001576 | DE | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | PT015144 | PA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 001939973 | 01 | PA | PA BLUE SHIELD | OTHER | 1018770990002 | 05 | PA | MEDICAID | 30070466 | 01 | PA | KEYSTONE MERCY | OTHER | 1942244850 | 05 | DE | MEDICAID | 3746091000 | 01 | DE | IBC | OTHER | 000053568 | 01 | DE | DPCI | OTHER |