Provider Demographics
NPI:1104050582
Name:DALPONTE, BRENDA L (LPTA)
Entity type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:L
Last Name:DALPONTE
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1964 E OAK RD UNIT J1
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08361-2587
Mailing Address - Country:US
Mailing Address - Phone:856-794-3346
Mailing Address - Fax:
Practice Address - Street 1:1964 E OAK RD UNIT J1
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08361-2587
Practice Address - Country:US
Practice Address - Phone:856-794-3346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-13
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB000109225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant