Healthcare Provider Details

I. General information

NPI: 1730650904
Provider Name (Legal Business Name): DELANEY MARIE CLOUSE PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 12/17/2021
Certification Date: 12/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6050 CAROLE DR
MILFORD OH
45150-2202
US

IV. Provider business mailing address

6050 CAROLE DR
MILFORD OH
45150-2202
US

V. Phone/Fax

Practice location:
  • Phone: 513-505-3859
  • Fax: 855-232-8604
Mailing address:
  • Phone: 513-505-3859
  • Fax: 855-232-8604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA012089
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: