Healthcare Provider Details

I. General information

NPI: 1750347407
Provider Name (Legal Business Name): MICHAEL F DELLORUSSO P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

388 HIGH ST
SOMERSWORTH NH
03878-1411
US

IV. Provider business mailing address

388 HIGH ST
SOMERSWORTH NH
03878-1411
US

V. Phone/Fax

Practice location:
  • Phone: 603-692-6626
  • Fax: 603-692-4766
Mailing address:
  • Phone: 603-692-6626
  • Fax: 603-692-4766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number2621
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: