Provider Demographics
NPI:1750347407
Name:DELLORUSSO, MICHAEL F (PT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:F
Last Name:DELLORUSSO
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 1:388 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:SOMERSWORTH
Mailing Address - State:NH
Mailing Address - Zip Code:03878-1411
Mailing Address - Country:US
Mailing Address - Phone:603-692-6626
Mailing Address - Fax:603-692-4766
Practice Address - Street 1:388 HIGH ST
Practice Address - Street 2:
Practice Address - City:SOMERSWORTH
Practice Address - State:NH
Practice Address - Zip Code:03878-1411
Practice Address - Country:US
Practice Address - Phone:603-692-6626
Practice Address - Fax:603-692-4766
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH26212251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH08Y002942NH03OtherANTHEM BLUE CROSS
NH30393894Medicaid
NH30393894Medicaid