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General NPI Number Information
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NPI Number | 1801576921
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Entity Type | Individual
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Provider Name | JOHN MICHAEL DELLOSO JR. PTA
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Gender | Male
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Dates
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Enumeration Date | 07/24/2023
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Last Update Date | 07/24/2023
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Provider Practice Location Address
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Address Line | 1940 S WEST BLVD STE A102
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City | VINELAND
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State | NJ
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Zip | 08360-7024
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Country | US
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Telephone | 856-690-9977
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Fax |
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Provider Business Mailing Address
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Address Line | 7 FRAZIER AVE
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City | BRIDGETON
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State | NJ
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Zip | 08302-1451
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Country | US
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Telephone | 609-315-6268
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 40QB00386000
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License Number State | NJ
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