Provider Demographics
NPI:1760762330
Name:DIPLACIDO, MARIO ANTHONY (PTA)
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:ANTHONY
Last Name:DIPLACIDO
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 E 26TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16504-2813
Mailing Address - Country:US
Mailing Address - Phone:814-451-1334
Mailing Address - Fax:
Practice Address - Street 1:607 E 26TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16504-2813
Practice Address - Country:US
Practice Address - Phone:814-451-1334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE008775225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant