Provider Demographics
NPI:1770189938
Name:DE PERALTA, ALDRIN PILANDE (DPT)
Entity Type:Individual
Prefix:
First Name:ALDRIN
Middle Name:PILANDE
Last Name:DE PERALTA
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 1:5276 BALFOR DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-2654
Mailing Address - Country:US
Mailing Address - Phone:757-277-8737
Mailing Address - Fax:
Practice Address - Street 1:6201 E VIRGINIA BEACH BLVD STE 110
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-2824
Practice Address - Country:US
Practice Address - Phone:757-261-0820
Practice Address - Fax:757-461-3246
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-11
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305205004225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist