Provider Demographics
NPI:1558902510
Name:PAZ DELGADO, JUAN CAMILO (DPT)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:CAMILO
Last Name:PAZ DELGADO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5105
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-5100
Mailing Address - Country:US
Mailing Address - Phone:103-323-8009
Mailing Address - Fax:910-251-0421
Practice Address - Street 1:5200 W 94TH TER STE 112
Practice Address - Street 2:
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66207-2534
Practice Address - Country:US
Practice Address - Phone:913-224-2990
Practice Address - Fax:913-224-2992
Is Sole Proprietor?:No
Enumeration Date:2019-10-01
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1106327225100000X
MO2019030127225100000X
NCCP029705T225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCCPO29705TOtherPT LICENSE