Provider Demographics
NPI:1689818320
Name:DELGADO, MARK LESTER MUYCO (PT)
Entity Type:Individual
Prefix:MR
First Name:MARK LESTER
Middle Name:MUYCO
Last Name:DELGADO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 S 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3521
Mailing Address - Country:US
Mailing Address - Phone:509-574-3600
Mailing Address - Fax:
Practice Address - Street 1:302 S 10TH AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3521
Practice Address - Country:US
Practice Address - Phone:509-574-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-24
Last Update Date:2014-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00010664225100000X
OR5546225100000X
NY028545225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist