Basic Information
| Provider Information | |||||||||
| NPI: | 1376605188 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEBLASIS | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1324 ROOSEVELT AVENUE | ||||||||
| Address2: | |||||||||
| City: | MARTINS FERRY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7406336243 | ||||||||
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| Practice Location | |||||||||
| Address1: | WHEELING HOSPITAL INC | ||||||||
| Address2: | 1 MEDICAL PARK | ||||||||
| City: | WHEELING | ||||||||
| State: | WV | ||||||||
| PostalCode: | 26003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042433124 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/15/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 245 | WV | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 3099L | 01 | PA | PENNSYLVANIA LICENSE | OTHER | 2973 | 01 | OH | OHIO LICENSE | OTHER |