Provider Demographics
NPI:1306134390
Name:DELROSARIO, PANTALEON (LPTA)
Entity type:Individual
Prefix:
First Name:PANTALEON
Middle Name:
Last Name:DELROSARIO
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 EAGLE POND DR
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33884-1296
Mailing Address - Country:US
Mailing Address - Phone:863-521-1909
Mailing Address - Fax:
Practice Address - Street 1:1201 EAGLE POND DR
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33884-1296
Practice Address - Country:US
Practice Address - Phone:863-521-1909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-12
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA20660225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant