Provider Demographics
NPI:1235774076
Name:DELGADO, ROD MARK B (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ROD MARK
Middle Name:B
Last Name:DELGADO
Suffix:
Gender:M
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 1:215 DEERPARK CT
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-2008
Mailing Address - Country:US
Mailing Address - Phone:609-481-5701
Mailing Address - Fax:
Practice Address - Street 1:215 DEERPARK CT
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-2008
Practice Address - Country:US
Practice Address - Phone:609-481-5701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-15
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01521500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist