Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 07164 | LA |
Y | 2251S0007X | Physical Therapist - Sports | J1-0002660 | DE |
NPI | 1235263591 |
---|---|
Provider Name | Mr. Mathew J Failla |
First Address | Newark, DE 19713-4904 |
Second Address | Newark, DE 19716 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2007 |
Last Update Date | 10/01/2011 |