Provider Demographics
NPI:1205182268
Name:DELMONT, MARIAH (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:MARIAH
Middle Name:
Last Name:DELMONT
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:NE
Mailing Address - Zip Code:68748-6009
Mailing Address - Country:US
Mailing Address - Phone:402-454-3373
Mailing Address - Fax:402-454-9021
Practice Address - Street 1:703 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:NE
Practice Address - Zip Code:68748-6009
Practice Address - Country:US
Practice Address - Phone:402-454-3373
Practice Address - Fax:402-454-9021
Is Sole Proprietor?:No
Enumeration Date:2012-07-27
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2213208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NENE2213OtherSTATE LICENSE NUMBER