Provider Demographics
NPI:1861507741
Name:DELUCA, TINA M (PT)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:M
Last Name:DELUCA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:M
Other - Last Name:DELUCA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20060 GOVERNORS DR STE 300
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461-1099
Mailing Address - Country:US
Mailing Address - Phone:708-283-2600
Mailing Address - Fax:708-283-1250
Practice Address - Street 1:20060 GOVERNORS DR
Practice Address - Street 2:
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1029
Practice Address - Country:US
Practice Address - Phone:708-283-2600
Practice Address - Fax:708-283-1250
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070013013225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist