Provider Demographics
NPI:1053685800
Name:FILART, RODERICK FORTUNATO B (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:RODERICK FORTUNATO
Middle Name:B
Last Name:FILART
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 E NAYLOR MILL RD UNIT F
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-2308
Mailing Address - Country:US
Mailing Address - Phone:443-944-0037
Mailing Address - Fax:443-210-2473
Practice Address - Street 1:701 E NAYLOR MILL RD UNIT F
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-2308
Practice Address - Country:US
Practice Address - Phone:443-944-0037
Practice Address - Fax:443-210-2473
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-25
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23211225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD286302200Medicaid