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NPI Code Detail

MEDICARE: MARY LEWIS DELCORE P.T.

MEDICARE: MARY LEWIS DELCORE P.T.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist6363-024WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1477508489
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY LEWIS DELCORE P.T.
Provider Business Mailing Address
First Line : N84W16889 MENOMONEE AVE
Second Line :
City : MENOMONEE FALLS
State : WI
Zip : 53051-2810
Country : US
Telephone Number : 262-251-7500
Fax Number :
Provider Business Practice Location Address
First Line : N84W16889 MENOMONEE AVE
Second Line :
City : MENOMONEE FALLS
State : WI
Zip : 53051-2810
Country : US
Telephone Number : 262-251-7500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2006
Last Update Date : 03/15/2022

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Directions to “ MARY LEWIS DELCORE P.T.” Practice Location

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