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General NPI Number Information
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NPI Number | 1336351741
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Entity Type | Individual
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Provider Name | PAULA DELORM
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Gender | Female
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Dates
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Enumeration Date | 05/06/2007
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Last Update Date | 08/15/2013
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Provider Practice Location Address
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Address Line | 6595 GRACEPOINT DR. SE
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City | CALEDONIA
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State | MI
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Zip | 49316
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Country | US
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Telephone | 616-540-0955
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Fax |
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Provider Business Mailing Address
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Address Line | 6595 GRACEPOINT DR. SE
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City | CALEDONIA
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State | MI
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Zip | 49316-8510
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501004188
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 4250
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License Number State | MA
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