Provider Demographics
NPI:1104503200
Name:DELLAPIETRO, MATTHEW (AT)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:DELLAPIETRO
Suffix:
Gender:M
Credentials:AT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7468 MEROLLA RD
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34291-5766
Mailing Address - Country:US
Mailing Address - Phone:941-544-0520
Mailing Address - Fax:
Practice Address - Street 1:7468 MEROLLA RD
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34291-5766
Practice Address - Country:US
Practice Address - Phone:941-544-0520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer