MEDICARE: DR. PAUL MICHAEL DELUCA D.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
1	225100000X	Physical Therapist	PT019623	PA

General Provider Information

NPI Number	:	1861639320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL MICHAEL DELUCA D.P.T.

Provider Business Mailing Address
First Line	:	2101 S COLUMBUS BLVD
Second Line	:	PENNSPORT PHYSICAL THERAPY
City	:	PHILADELPHIA
State	:	PA
Zip	:	19148-2805
Country	:	US
Telephone Number	:	215-467-4660
Fax Number	:	215-467-8879

Provider Business Practice Location Address
First Line	:	2101 S COLUMBUS BLVD
Second Line	:	PENNSPORT PHYSICAL THERAPY
City	:	PHILADELPHIA
State	:	PA
Zip	:	19148-2805
Country	:	US
Telephone Number	:	215-467-4660
Fax Number	:	215-467-8879

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/20/2009
Last Update Date	:	01/20/2009

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