Healthcare Provider Details

I. General information

NPI: 1295795532
Provider Name (Legal Business Name): GRETCHEN ANN DELAC P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E WASHINGTON ST REHAB DEPT.
MEDINA OH
44256-2170
US

IV. Provider business mailing address

4092 FOREST RUN CIR
MEDINA OH
44256-6444
US

V. Phone/Fax

Practice location:
  • Phone: 330-725-1000
  • Fax: 330-721-4913
Mailing address:
  • Phone: 330-721-0700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number7998
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: