Healthcare Provider Details

I. General information

NPI: 1730212945
Provider Name (Legal Business Name): PATRICIA ANN DELTUVA PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1454 FAIRFIELD LOOP RD
CROWNSVILLE MD
21032-2006
US

IV. Provider business mailing address

588 FOREST VIEW RD
LINTHICUM HEIGHTS MD
21090-2818
US

V. Phone/Fax

Practice location:
  • Phone: 410-923-6820
  • Fax: 410-923-2783
Mailing address:
  • Phone: 410-859-1248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA2055
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: