Individual
WILLIE T BASCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
33 DEAK DR, SUITE 101, SMYRNA, DE 19977-1268
(302) 659-5700
(302) 659-5703
Mailing address
2 W 10TH ST, MARCUS HOOK, PA 19061-4513
(610) 859-8850
(610) 859-7876
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
J10002517
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000020536
DPCI
DE
05
—
1477889624
—
DE
01
—
3768331000
IBC
DE
Enumeration date
10/22/2009
Last updated
06/18/2010
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