Provider Demographics
NPI:1649390931
Name:DELUCA, SHELLIE K (PT)
Entity Type:Individual
Prefix:MRS
First Name:SHELLIE
Middle Name:K
Last Name:DELUCA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5501 WEYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-4531
Mailing Address - Country:US
Mailing Address - Phone:410-429-4445
Mailing Address - Fax:
Practice Address - Street 1:16 FUSTING AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21228-4413
Practice Address - Country:US
Practice Address - Phone:410-747-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17812225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist