Provider Demographics
NPI:1518138767
Name:VERZOSA, REGIDOR ADRIANO (PT)
Entity Type:Individual
Prefix:
First Name:REGIDOR
Middle Name:ADRIANO
Last Name:VERZOSA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:MARCUS HOOK
Mailing Address - State:PA
Mailing Address - Zip Code:19061-4513
Mailing Address - Country:US
Mailing Address - Phone:610-859-8850
Mailing Address - Fax:610-859-7876
Practice Address - Street 1:26396 BAY FARM RD
Practice Address - Street 2:UNIT 1
Practice Address - City:MILLSBORO
Practice Address - State:DE
Practice Address - Zip Code:19966-4993
Practice Address - Country:US
Practice Address - Phone:302-947-9662
Practice Address - Fax:302-947-9692
Is Sole Proprietor?:No
Enumeration Date:2008-03-17
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0002290225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
252522OtherUNISON
DEP00885367OtherRAILROAD MEDICARE
DE3780062000OtherIBC
DE1518138767OtherDPCI
DE1518138767Medicaid
DE176060ZB82Medicare PIN