Provider Demographics
NPI:1861099228
Name:DEL CID, MYNOR DAVID (PTA)
Entity type:Individual
Prefix:
First Name:MYNOR
Middle Name:DAVID
Last Name:DEL CID
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 150TH AVE NE APT A
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-5048
Mailing Address - Country:US
Mailing Address - Phone:562-746-7100
Mailing Address - Fax:
Practice Address - Street 1:101 150TH AVE NE APT A
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-5048
Practice Address - Country:US
Practice Address - Phone:562-746-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-07
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP160984888225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant