Provider Demographics
NPI:1962461525
Name:DELROSARIO, NOEL (PT)
Entity Type:Individual
Prefix:
First Name:NOEL
Middle Name:
Last Name:DELROSARIO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3125 CALUMET AVENUE
Mailing Address - Street 2:STE 9
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383
Mailing Address - Country:US
Mailing Address - Phone:219-548-8770
Mailing Address - Fax:219-548-8771
Practice Address - Street 1:3125 CALUMET AVENUE
Practice Address - Street 2:STE 9
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383
Practice Address - Country:US
Practice Address - Phone:219-548-8770
Practice Address - Fax:219-548-8771
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05004553A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200431330Medicaid
IN203440BMedicare PIN
IN200431330Medicaid
INP00096185Medicare PIN