Provider Demographics
NPI:1225611122
Name:HILARIO, EMILSON THEODORE
Entity Type:Individual
Prefix:
First Name:EMILSON
Middle Name:THEODORE
Last Name:HILARIO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11340 PEMBROOKE SQ STE 211
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-4808
Mailing Address - Country:US
Mailing Address - Phone:240-530-8188
Mailing Address - Fax:
Practice Address - Street 1:11340 PEMBROOKE SQ STE 211
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-4808
Practice Address - Country:US
Practice Address - Phone:240-530-8188
Practice Address - Fax:301-638-0470
Is Sole Proprietor?:No
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA4698225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant