Provider Demographics
NPI:1598075301
Name:DELAGE, ELIZABETH (PTA)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:
Last Name:DELAGE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOX 111
Mailing Address - Street 2:8 UPLAND RD.
Mailing Address - City:ONSET,
Mailing Address - State:MA
Mailing Address - Zip Code:02558-0111
Mailing Address - Country:US
Mailing Address - Phone:508-479-8379
Mailing Address - Fax:
Practice Address - Street 1:761 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-3722
Practice Address - Country:US
Practice Address - Phone:508-679-1411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA150225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant