Provider Demographics
NPI:1720353857
Name:PARAN, DERLITH DIZON (PT)
Entity type:Individual
Prefix:MRS
First Name:DERLITH
Middle Name:DIZON
Last Name:PARAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5425 APPOMATTOX RD
Mailing Address - Street 2:APT 5
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52806-2376
Mailing Address - Country:US
Mailing Address - Phone:954-695-4808
Mailing Address - Fax:
Practice Address - Street 1:5900 WEST SAMPLE ROAD
Practice Address - Street 2:APT. 304
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-3268
Practice Address - Country:US
Practice Address - Phone:954-695-4808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-22
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.018954225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist