Healthcare Provider Details

I. General information

NPI: 1104593359
Provider Name (Legal Business Name): DYLAN B DELANCEY DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2021
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4010 BIENVILLE BLVD UNIT E
OCEAN SPRINGS MS
39564-5990
US

IV. Provider business mailing address

4714 MILESTONE LN
CASTLE ROCK CO
80104-7907
US

V. Phone/Fax

Practice location:
  • Phone: 228-300-6001
  • Fax: 228-300-6005
Mailing address:
  • Phone: 303-660-5349
  • Fax: 717-773-4654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP049062T
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT7224
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: