Provider Demographics
NPI:1861639320
Name:DELUCA, PAUL MICHAEL (DPT)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:MICHAEL
Last Name:DELUCA
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Gender:M
Credentials:DPT
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Mailing Address - Street 1:2101 S COLUMBUS BLVD
Mailing Address - Street 2:PENNSPORT PHYSICAL THERAPY
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19148-2805
Mailing Address - Country:US
Mailing Address - Phone:215-467-4660
Mailing Address - Fax:215-467-8879
Practice Address - Street 1:2101 S COLUMBUS BLVD
Practice Address - Street 2:PENNSPORT PHYSICAL THERAPY
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19148-2805
Practice Address - Country:US
Practice Address - Phone:215-467-4660
Practice Address - Fax:215-467-8879
Is Sole Proprietor?:No
Enumeration Date:2009-01-20
Last Update Date:2009-01-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAPT019623225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist