Kevin Dimarco
Individual provider Active NPI Physical Therapy Assistant · Clarksburg, MD
NPI 1194263111 · NPPES record last updated Feb 9, 2017
Key facts
- NPI
- 1194263111
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapy Assistant 225200000X
- License
- A4478 (MD)
- Practice address
- 12409 Needle Dr
Clarksburg, MD 20871-9208 - Phone
- (301) 807-7368
- NPI assigned
- Feb 9, 2017
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A4478 | MD | MD | Physical Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | A4478 | MD | Yes |
Addresses
Primary practice location
12409 Needle Dr
Clarksburg, MD 20871-9208
Mailing address
12409 Needle Dr
Clarksburg, MD 20871-9208
Phone (301) 807-7368
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All providers in Clarksburg, MD · Physical Therapy Assistant in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 9, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.