Provider Demographics
NPI:1730650904
Name:CLOUSE, DELANEY MARIE (PTA)
Entity Type:Individual
Prefix:
First Name:DELANEY
Middle Name:MARIE
Last Name:CLOUSE
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 1:6050 CAROLE DR
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45150-2202
Mailing Address - Country:US
Mailing Address - Phone:513-505-3859
Mailing Address - Fax:855-232-8604
Practice Address - Street 1:6050 CAROLE DR
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:OH
Practice Address - Zip Code:45150-2202
Practice Address - Country:US
Practice Address - Phone:513-505-3859
Practice Address - Fax:855-232-8604
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA012089225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant