Provider Demographics
NPI:1770852352
Name:DELGADO, DINA LYNN (PT)
Entity type:Individual
Prefix:
First Name:DINA
Middle Name:LYNN
Last Name:DELGADO
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 1:165 BARBARA BND
Mailing Address - Street 2:
Mailing Address - City:UNIVERSAL CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78148-3635
Mailing Address - Country:US
Mailing Address - Phone:516-849-6330
Mailing Address - Fax:
Practice Address - Street 1:165 BARBARA BND
Practice Address - Street 2:
Practice Address - City:UNIVERSAL CITY
Practice Address - State:TX
Practice Address - Zip Code:78148-3635
Practice Address - Country:US
Practice Address - Phone:516-849-6330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-27
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1037802225100000X
NY011169-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist