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General NPI Number Information
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NPI Number | 1720353857
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Entity Type | Individual
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Provider Name | DERLITH DIZON PARAN PT
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Gender | Female
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Dates
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Enumeration Date | 03/22/2012
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Last Update Date | 09/06/2012
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Provider Practice Location Address
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Address Line | 5900 WEST SAMPLE ROAD APT. 304
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City | CORAL SPRINGS
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State | FL
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Zip | 33067-3268
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Country | US
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Telephone | 954-695-4808
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Fax |
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Provider Business Mailing Address
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Address Line | 5425 APPOMATTOX RD APT 5
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City | DAVENPORT
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State | IA
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Zip | 52806-2376
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Country | US
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Telephone | 954-695-4808
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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 | 070.018954
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License Number State | IL
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