Provider Demographics
NPI:1134471923
Name:DELNODAL, DENISE MARY (LMT)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:MARY
Last Name:DELNODAL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MS
Other - First Name:DENISE
Other - Middle Name:M
Other - Last Name:DELNODAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:235 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:PA
Mailing Address - Zip Code:18644-2010
Mailing Address - Country:US
Mailing Address - Phone:510-609-5370
Mailing Address - Fax:570-609-5372
Practice Address - Street 1:235 E 8TH ST
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:PA
Practice Address - Zip Code:18644-2010
Practice Address - Country:US
Practice Address - Phone:510-609-5370
Practice Address - Fax:570-609-5372
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG003663173C00000X, 175L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist
No175L00000XOther Service ProvidersHomeopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA175L00000XMedicare UPIN
PA173C00000XMedicare UPIN