Provider Demographics
NPI:1972022739
Name:DELANEY, LOIS M (PTA)
Entity type:Individual
Prefix:
First Name:LOIS
Middle Name:M
Last Name:DELANEY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 DALY AVE
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:MA
Mailing Address - Zip Code:01226-1528
Mailing Address - Country:US
Mailing Address - Phone:413-684-0943
Mailing Address - Fax:
Practice Address - Street 1:56 DALY AVE
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:MA
Practice Address - Zip Code:01226-1528
Practice Address - Country:US
Practice Address - Phone:413-684-0943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-13
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7751208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA7751OtherDIVISION OF PROFESSIONAL LICENSURE