Provider Demographics
NPI:1508393059
Name:DELGADO, MARY ELAINE (PERSONAL TRAINER)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELAINE
Last Name:DELGADO
Suffix:
Gender:F
Credentials:PERSONAL TRAINER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10211 CHARTER OAKS DR
Mailing Address - Street 2:
Mailing Address - City:DAVISON
Mailing Address - State:MI
Mailing Address - Zip Code:48423-3340
Mailing Address - Country:US
Mailing Address - Phone:810-624-5669
Mailing Address - Fax:
Practice Address - Street 1:4500 S SAGINAW ST
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-2676
Practice Address - Country:US
Practice Address - Phone:810-265-7121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-15
Last Update Date:2017-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1501202226300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist