Provider Demographics
NPI:1194001255
Name:DELAINI, JUSTIN (ATC, CSCS, PES)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:
Last Name:DELAINI
Suffix:
Gender:M
Credentials:ATC, CSCS, PES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 E CHURCH ST STE 1100
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:PA
Mailing Address - Zip Code:15501-2271
Mailing Address - Country:US
Mailing Address - Phone:814-445-3330
Mailing Address - Fax:
Practice Address - Street 1:126 E CHURCH ST STE 1100
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:PA
Practice Address - Zip Code:15501-2271
Practice Address - Country:US
Practice Address - Phone:814-445-3330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARTO0000492255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer