Provider Demographics
NPI:1679520597
Name:DALONZO-BAKER, THOMAS HOWARD (MPT)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:HOWARD
Last Name:DALONZO-BAKER
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4030 WAKE FOREST RD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-6800
Mailing Address - Country:US
Mailing Address - Phone:919-872-2828
Mailing Address - Fax:919-872-8138
Practice Address - Street 1:4030 WAKE FOREST RD
Practice Address - Street 2:SUITE 211
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6800
Practice Address - Country:US
Practice Address - Phone:919-872-2828
Practice Address - Fax:919-872-8138
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7516225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2502793Medicare ID - Type Unspecified