Provider Demographics
NPI:1609837897
Name:DELEO, VINCENT J (PT)
Entity Type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:J
Last Name:DELEO
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 1:725 WALKER RD
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904
Mailing Address - Country:US
Mailing Address - Phone:302-678-3100
Mailing Address - Fax:302-678-3104
Practice Address - Street 1:725 WALKER RD
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904
Practice Address - Country:US
Practice Address - Phone:302-678-3100
Practice Address - Fax:302-678-3104
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE103225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
R29305OtherMEDICARE BLUE
DE119113P83Medicare PIN