Provider Demographics
NPI:1760494868
Name:DELLAPENA, MICHAEL J (MSPT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:DELLAPENA
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 LYNDON FARM CT STE 300
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5005
Mailing Address - Country:US
Mailing Address - Phone:856-677-4000
Mailing Address - Fax:856-234-3014
Practice Address - Street 1:790 PENLLYN BLUE BELL PIKE STE 101
Practice Address - Street 2:
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-1657
Practice Address - Country:US
Practice Address - Phone:267-419-8160
Practice Address - Fax:267-419-8761
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT012469L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA068058Medicare ID - Type UnspecifiedGROUP MEDICARE #
PA068060RKSMedicare ID - Type UnspecifiedINDIVIDUAL MEDICARE #