Basic Information
| Provider Information | |||||||||
| NPI: | 1407882442 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STANWOOD | ||||||||
| FirstName: | MICHAEL | ||||||||
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| Credential: | PT, ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1812 MARSH RD | ||||||||
| Address2: | STORE 505 | ||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 198104581 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3027931800 | ||||||||
| FaxNumber: | 3027930800 | ||||||||
| Practice Location | |||||||||
| Address1: | 42-46 E STREET RD | ||||||||
| Address2: | STORE 505 | ||||||||
| City: | WEST CHESTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19382 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103998600 | ||||||||
| FaxNumber: | 6103998601 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2006 | ||||||||
| LastUpdateDate: | 03/03/2009 | ||||||||
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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 | J10001056 | DE | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | PT011355L | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 284043 | 01 | PA BS | OTHER | 1000037720 | 05 | DE | MEDICAID | 1456769 | 01 | PABS | OTHER | 0706621000 | 01 | AMERIHEALTH | OTHER |