Provider Demographics
NPI:1376532382
Name:DELUCA, ELIZABETH (PT, OCS)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:DELUCA
Suffix:
Gender:F
Credentials:PT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 SMOKERISE DR
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-8702
Mailing Address - Country:US
Mailing Address - Phone:330-335-4200
Mailing Address - Fax:330-335-7131
Practice Address - Street 1:145 SMOKERISE DR
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-8702
Practice Address - Country:US
Practice Address - Phone:330-335-4200
Practice Address - Fax:330-335-7131
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT054632251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2294002Medicaid
OH0879881Medicare ID - Type Unspecified