Healthcare Provider Details

I. General information

NPI: 1639607492
Provider Name (Legal Business Name): MARK STEPHEN DELVECCHIO PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2017
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 EDWARDS VILLAGE BLVD # A-203
EDWARDS CO
81632-5277
US

IV. Provider business mailing address

210 EDWARDS VILLAGE BLVD # A-203
EDWARDS CO
81632-5277
US

V. Phone/Fax

Practice location:
  • Phone: 970-230-1915
  • Fax: 970-446-2022
Mailing address:
  • Phone: 970-230-1915
  • Fax: 970-446-2022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number0014747
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: