Basic Information
| Provider Information | |||||||||
| NPI: | 1437260353 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DELAGE | ||||||||
| FirstName: | PATTI | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30 GLENNIE ST | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016053917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5087918740 | ||||||||
| FaxNumber: | 5087523716 | ||||||||
| Practice Location | |||||||||
| Address1: | 30 GLENNIE ST | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016053917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5087918740 | ||||||||
| FaxNumber: | 5087523716 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 09/02/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 6057 | MA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 0334031 | 05 | MA | MEDICAID | 626330 | 01 | MA | HARVARD PILGRIM | OTHER | 64029 | 01 | MA | AETNA | OTHER | 981075 | 01 | MA | NETWORK HEALTH | OTHER | Y66525 | 01 | MA | BLUE CROSS | OTHER | 468028 | 01 | MA | TUFTS | OTHER | 328820 | 01 | MA | CIGNA | OTHER |