Provider Demographics
NPI:1073790887
Name:DELONDE LLC
Entity Type:Organization
Organization Name:DELONDE LLC
Other - Org Name:PHYSICAL THERAPY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:LYNNE MILLER
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:303-258-7980
Mailing Address - Street 1:PO BOX 2016
Mailing Address - Street 2:
Mailing Address - City:NEDERLAND
Mailing Address - State:CO
Mailing Address - Zip Code:80466-2016
Mailing Address - Country:US
Mailing Address - Phone:303-258-7980
Mailing Address - Fax:
Practice Address - Street 1:907 COUNTY ROAD 126
Practice Address - Street 2:
Practice Address - City:NEDERLAND
Practice Address - State:CO
Practice Address - Zip Code:80466-2016
Practice Address - Country:US
Practice Address - Phone:303-258-7980
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5153171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty