Provider Demographics
NPI:1205317294
Name:DELUCA, LAURA ROSE (PT, DPT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ROSE
Last Name:DELUCA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:ROSE
Other - Last Name:CIANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:935 ALLWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07012-1988
Mailing Address - Country:US
Mailing Address - Phone:973-928-3590
Mailing Address - Fax:
Practice Address - Street 1:265 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-2712
Practice Address - Country:US
Practice Address - Phone:973-661-1207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01804400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist