Healthcare Provider Details

I. General information

NPI: 1831557545
Provider Name (Legal Business Name): DELIA BERTONI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2016
Last Update Date: 02/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 PINE GROVE ST NW
GRAND RAPIDS MI
49504-2942
US

IV. Provider business mailing address

1321 PINE GROVE ST NW
GRAND RAPIDS MI
49504-2942
US

V. Phone/Fax

Practice location:
  • Phone: 616-940-0040
  • Fax:
Mailing address:
  • Phone: 616-940-0040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: