Provider Demographics
NPI:1710142609
Name:DELRE, MICHAEL T, (DPT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:T,
Last Name:DELRE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 INDUSTRIAL DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47025-1116
Mailing Address - Country:US
Mailing Address - Phone:812-537-5616
Mailing Address - Fax:812-537-1804
Practice Address - Street 1:120 INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:IN
Practice Address - Zip Code:47025-1116
Practice Address - Country:US
Practice Address - Phone:812-537-5616
Practice Address - Fax:812-537-1804
Is Sole Proprietor?:No
Enumeration Date:2008-07-21
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05009629A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN151000IMedicare PIN
INP00864096Medicare PIN