MEDICARE: CARRIE A DELORENZO PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	005970-1	NY

General Provider Information

NPI Number	:	1578775144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARRIE A DELORENZO PTA

Provider Business Mailing Address
First Line	:	163 ORCHARD DR
Second Line	:
City	:	GARDINER
State	:	NY
Zip	:	12525-5710
Country	:	US
Telephone Number	:	845-883-0095
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 WINDGATE WAY
Second Line	:
City	:	HIGHLAND
State	:	NY
Zip	:	12528-2143
Country	:	US
Telephone Number	:	845-691-6800
Fax Number	:	845-691-2858

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	07/08/2007

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