Provider Demographics
NPI:1669819058
Name:DELLOTA, MARIA EVERLASTING (PT)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:EVERLASTING
Last Name:DELLOTA
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 1:35 BUSINESS DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-4499
Mailing Address - Country:US
Mailing Address - Phone:956-517-1235
Mailing Address - Fax:888-588-3234
Practice Address - Street 1:35 BUSINESS DR
Practice Address - Street 2:SUITE C
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-4499
Practice Address - Country:US
Practice Address - Phone:956-517-1235
Practice Address - Fax:888-588-3234
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-27
Last Update Date:2013-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1229659225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1229659OtherECPTOTE