Provider Demographics
NPI:1689797003
Name:LEBLO, DELIA ANN (PTA)
Entity Type:Individual
Prefix:MS
First Name:DELIA
Middle Name:ANN
Last Name:LEBLO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2109 BAYSHORE BLVD
Mailing Address - Street 2:#302
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-3155
Mailing Address - Country:US
Mailing Address - Phone:813-263-7681
Mailing Address - Fax:
Practice Address - Street 1:12425 RACE TRACK RD
Practice Address - Street 2:SUITE 100
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-3118
Practice Address - Country:US
Practice Address - Phone:813-471-0152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA 14118225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant