Provider Demographics
NPI:1275636359
Name:SPENCE DELGADO, MARLIESE (MS, PT)
Entity Type:Individual
Prefix:MS
First Name:MARLIESE
Middle Name:
Last Name:SPENCE DELGADO
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 OSLO CIR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35211-5965
Mailing Address - Country:US
Mailing Address - Phone:205-944-3944
Mailing Address - Fax:205-413-4914
Practice Address - Street 1:120 OSLO CIR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35211-5965
Practice Address - Country:US
Practice Address - Phone:205-944-3944
Practice Address - Fax:205-413-4914
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH2643225100000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
51037761OtherBCBS
AL890004070Medicaid
ALAL0781Medicare UPIN