Provider Demographics
NPI:1508258872
Name:DELA PENA, AIREEN CENTENO (PT)
Entity Type:Individual
Prefix:
First Name:AIREEN
Middle Name:CENTENO
Last Name:DELA PENA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:AIREEN
Other - Middle Name:ANGELO
Other - Last Name:CENTENO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3420 WAKE FOREST RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-3522
Mailing Address - Country:US
Mailing Address - Phone:919-596-9464
Mailing Address - Fax:
Practice Address - Street 1:3420 WAKE FOREST RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-3522
Practice Address - Country:US
Practice Address - Phone:919-596-9464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-24
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP9998225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist