Provider Demographics
NPI:1902924178
Name:DELVISCIO, THOMAS X (PT, DPT)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:X
Last Name:DELVISCIO
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3933 57TH ST
Mailing Address - Street 2:APT # 2E
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-3359
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1633 BROADWAY
Practice Address - Street 2:LEVEL 1C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-6708
Practice Address - Country:US
Practice Address - Phone:212-315-9578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027442-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPENDINGMedicare ID - Type Unspecified