Provider Demographics
NPI:1376594077
Name:DELAROSA, MARIA CHEY
Entity Type:Individual
Prefix:
First Name:MARIA CHEY
Middle Name:
Last Name:DELAROSA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 N OLD DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159-4347
Mailing Address - Country:US
Mailing Address - Phone:352-751-6627
Mailing Address - Fax:352-751-6628
Practice Address - Street 1:134 N OLD DIXIE HWY
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-4347
Practice Address - Country:US
Practice Address - Phone:352-751-6627
Practice Address - Fax:352-751-6628
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT21681225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU3792ZMedicare ID - Type Unspecified