Provider Demographics
NPI:1134226830
Name:DELVICARIO, JOSEPH LOUIS (PT)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:LOUIS
Last Name:DELVICARIO
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 1:2630 SAWYER TER
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6480
Mailing Address - Country:US
Mailing Address - Phone:561-389-1698
Mailing Address - Fax:561-784-7288
Practice Address - Street 1:2630 SAWYER TER
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6480
Practice Address - Country:US
Practice Address - Phone:561-389-1698
Practice Address - Fax:561-784-7288
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT18503225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU2892Medicare UPIN