Provider Demographics
NPI:1366552259
Name:DOLISI, STEVEN T (PTA)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:T
Last Name:DOLISI
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 1:1374 FALLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-9440
Mailing Address - Country:US
Mailing Address - Phone:386-748-0368
Mailing Address - Fax:386-574-2023
Practice Address - Street 1:1555 SAXON BLVD STE 101-102
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-5861
Practice Address - Country:US
Practice Address - Phone:386-574-5247
Practice Address - Fax:386-574-2023
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPTA15909OtherLICENSE #