Provider Demographics
NPI:1245684570
Name:DELVALLE, VINCENT PAUL (ATC)
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:PAUL
Last Name:DELVALLE
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 KALAMAZOO ST STE 106
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-5400
Mailing Address - Country:US
Mailing Address - Phone:517-884-7378
Mailing Address - Fax:517-432-1832
Practice Address - Street 1:223 KALAMAZOO ST STE 106
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48824-5400
Practice Address - Country:US
Practice Address - Phone:517-884-7378
Practice Address - Fax:517-432-1832
Is Sole Proprietor?:No
Enumeration Date:2016-04-23
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI26010013402255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer