Provider Demographics
NPI:1952674954
Name:DELANTAR, HERMINIGILDA DADULIA (PT)
Entity Type:Individual
Prefix:MRS
First Name:HERMINIGILDA
Middle Name:DADULIA
Last Name:DELANTAR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:AMIE
Other - Middle Name:
Other - Last Name:DELANTAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:211 W PINE LAKE DRIVE
Mailing Address - Street 2:
Mailing Address - City:NEWAYGO
Mailing Address - State:MI
Mailing Address - Zip Code:49337
Mailing Address - Country:US
Mailing Address - Phone:231-652-5381
Mailing Address - Fax:231-652-5385
Practice Address - Street 1:211 W PINE LAKE DRIVE
Practice Address - Street 2:
Practice Address - City:NEWAYGO
Practice Address - State:MI
Practice Address - Zip Code:49337
Practice Address - Country:US
Practice Address - Phone:231-652-5381
Practice Address - Fax:231-652-5385
Is Sole Proprietor?:No
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI55010112012251G0304X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics