Provider Demographics
NPI:1841495686
Name:DELGROS, JACQUELINE (LPTA)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:DELGROS
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 CAMBRIA ST
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-1373
Mailing Address - Country:US
Mailing Address - Phone:724-346-9139
Mailing Address - Fax:
Practice Address - Street 1:1330 KIMBERLY RD
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:PA
Practice Address - Zip Code:16146-3731
Practice Address - Country:US
Practice Address - Phone:724-347-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEI003122225200000X
OHPTA5190225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant