Provider Demographics
NPI:1174033823
Name:ISTRATE, DELIA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:DELIA
Middle Name:
Last Name:ISTRATE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 10TH ST
Mailing Address - Street 2:
Mailing Address - City:PORT ROYAL
Mailing Address - State:SC
Mailing Address - Zip Code:29935-2310
Mailing Address - Country:US
Mailing Address - Phone:843-310-9690
Mailing Address - Fax:800-317-9690
Practice Address - Street 1:1004 10TH ST
Practice Address - Street 2:
Practice Address - City:PORT ROYAL
Practice Address - State:SC
Practice Address - Zip Code:29935-2310
Practice Address - Country:US
Practice Address - Phone:843-310-9690
Practice Address - Fax:800-317-9690
Is Sole Proprietor?:No
Enumeration Date:2017-10-09
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8699225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist