Healthcare Provider Details

I. General information

NPI: 1558873372
Provider Name (Legal Business Name): PATRICK MICHAEL DELEONIBUS PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2017
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 PROVIDENCE RD STE 80
VIRGINIA BEACH VA
23464-4128
US

IV. Provider business mailing address

790 REMINGTON BLVD
BOLINGBROOK IL
60440-4909
US

V. Phone/Fax

Practice location:
  • Phone: 757-467-4604
  • Fax: 757-467-2716
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305211609
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: