Healthcare Provider Details

I. General information

NPI: 1508393059
Provider Name (Legal Business Name): MARY ELAINE DELGADO PERSONAL TRAINER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2017
Last Update Date: 06/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 S SAGINAW ST
FLINT MI
48507-2676
US

IV. Provider business mailing address

10211 CHARTER OAKS DR
DAVISON MI
48423-3340
US

V. Phone/Fax

Practice location:
  • Phone: 810-265-7121
  • Fax:
Mailing address:
  • Phone: 810-624-5669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code226300000X
TaxonomyKinesiotherapist
License Number1501202
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: