Provider Demographics
NPI:1386047926
Name:DELCOLLADO, AMY LENORE (PTA)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:LENORE
Last Name:DELCOLLADO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5209 LAWNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33617-4033
Mailing Address - Country:US
Mailing Address - Phone:813-695-3844
Mailing Address - Fax:
Practice Address - Street 1:8254 118TH AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33773-5017
Practice Address - Country:US
Practice Address - Phone:727-541-5304
Practice Address - Fax:727-546-8527
Is Sole Proprietor?:No
Enumeration Date:2014-09-26
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPTA21281225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant