Healthcare Provider Details

I. General information

NPI: 1114571502
Provider Name (Legal Business Name): NICOLE DELIA DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2019
Last Update Date: 02/23/2022
Certification Date: 02/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5281 N 99TH AVE STE 200
GLENDALE AZ
85305-3199
US

IV. Provider business mailing address

9097 E DESERT COVE AVE STE 110
SCOTTSDALE AZ
85260-6276
US

V. Phone/Fax

Practice location:
  • Phone: 623-889-0411
  • Fax: 623-889-0410
Mailing address:
  • Phone: 480-551-4965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: