Provider Demographics
NPI:1275258113
Name:DELVECCHIO PHYSICAL THERAPY
Entity Type:Organization
Organization Name:DELVECCHIO PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:DELVECCHIO
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:508-517-0498
Mailing Address - Street 1:PO BOX 560
Mailing Address - Street 2:
Mailing Address - City:WOLCOTT
Mailing Address - State:CO
Mailing Address - Zip Code:81655-0560
Mailing Address - Country:US
Mailing Address - Phone:970-230-1915
Mailing Address - Fax:
Practice Address - Street 1:210 EDWARDS VILLAGE BLVD # A-203
Practice Address - Street 2:
Practice Address - City:EDWARDS
Practice Address - State:CO
Practice Address - Zip Code:81632-5277
Practice Address - Country:US
Practice Address - Phone:970-230-1915
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy