Provider Demographics
NPI:1932882008
Name:DELUCCA, GABRIELLE QUINN
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:QUINN
Last Name:DELUCCA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 REGENCY DR
Mailing Address - Street 2:
Mailing Address - City:NORTH WALES
Mailing Address - State:PA
Mailing Address - Zip Code:19454-1616
Mailing Address - Country:US
Mailing Address - Phone:215-534-8049
Mailing Address - Fax:
Practice Address - Street 1:2804 SOUTHAMPTON RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19154-1207
Practice Address - Country:US
Practice Address - Phone:215-677-0930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT031470225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist