Provider Demographics
NPI:1811061492
Name:DELLOVA, RANDI ALISE (PT)
Entity type:Individual
Prefix:MRS
First Name:RANDI
Middle Name:ALISE
Last Name:DELLOVA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:RANDI
Other - Middle Name:ALISE
Other - Last Name:PERLMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-2309
Mailing Address - Country:US
Mailing Address - Phone:914-993-3350
Mailing Address - Fax:
Practice Address - Street 1:2 N BROADWAY
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-2309
Practice Address - Country:US
Practice Address - Phone:914-993-3350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024107-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWZVZZ1Medicare PIN