Provider Demographics
NPI:1740666072
Name:DELVALLE, ROSA (PT)
Entity type:Individual
Prefix:MRS
First Name:ROSA
Middle Name:
Last Name:DELVALLE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 LIVINGSTON AVE BLDG C
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44052-3781
Mailing Address - Country:US
Mailing Address - Phone:440-233-1070
Mailing Address - Fax:440-233-1056
Practice Address - Street 1:1800 LIVINGSTON AVE BLDG C
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44052-3781
Practice Address - Country:US
Practice Address - Phone:440-233-1070
Practice Address - Fax:440-233-1056
Is Sole Proprietor?:No
Enumeration Date:2015-08-10
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH005240225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist