Provider Demographics
NPI:1457162984
Name:DELTA PHYSIO AND WELLNESS SERVICES PLLC
Entity type:Organization
Organization Name:DELTA PHYSIO AND WELLNESS SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:GERLITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-757-1818
Mailing Address - Street 1:10509 PATTERSON AVE # PO29111
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23242-1251
Mailing Address - Country:US
Mailing Address - Phone:302-757-1818
Mailing Address - Fax:
Practice Address - Street 1:1512 HELMSDALE DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23238-4722
Practice Address - Country:US
Practice Address - Phone:302-757-1818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-15
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty