Provider Demographics
NPI:1659499093
Name:SIBBALUCA, DELINARD
Entity Type:Individual
Prefix:MR
First Name:DELINARD
Middle Name:
Last Name:SIBBALUCA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 W ROMINES CIR
Mailing Address - Street 2:
Mailing Address - City:DALZELL
Mailing Address - State:IL
Mailing Address - Zip Code:61320-9750
Mailing Address - Country:US
Mailing Address - Phone:815-223-4901
Mailing Address - Fax:
Practice Address - Street 1:1301 21ST ST
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:IL
Practice Address - Zip Code:61354-1359
Practice Address - Country:US
Practice Address - Phone:815-223-4901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist