Provider Demographics
NPI:1891752655
Name:DEL VENTO, MARY A (RPT)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:A
Last Name:DEL VENTO
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4263 VIXEN CT
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-7558
Mailing Address - Country:US
Mailing Address - Phone:407-366-4877
Mailing Address - Fax:407-366-4877
Practice Address - Street 1:4263 VIXEN CT
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-7558
Practice Address - Country:US
Practice Address - Phone:407-366-4877
Practice Address - Fax:407-366-4877
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20662251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics