Provider Demographics
NPI:1568127876
Name:DELA PAZ, DEO MAULEON (PT)
Entity Type:Individual
Prefix:
First Name:DEO
Middle Name:MAULEON
Last Name:DELA PAZ
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 1:7014 136TH ST
Mailing Address - Street 2:UNIT A
Mailing Address - City:KEW GARDEN HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11367-1947
Mailing Address - Country:US
Mailing Address - Phone:646-416-4513
Mailing Address - Fax:
Practice Address - Street 1:8701 MIDLAND PKWY STE LC
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-4715
Practice Address - Country:US
Practice Address - Phone:646-849-5562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-02
Last Update Date:2022-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0380972251G0304X, 2251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic