Provider Demographics
NPI:1306846985
Name:PROTHERO, RICK NELSON (PT)
Entity Type:Individual
Prefix:MR
First Name:RICK
Middle Name:NELSON
Last Name:PROTHERO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807A S UNION AVE
Mailing Address - Street 2:
Mailing Address - City:HAVRE DE GRACE
Mailing Address - State:MD
Mailing Address - Zip Code:21078-3610
Mailing Address - Country:US
Mailing Address - Phone:410-939-2262
Mailing Address - Fax:410-939-7119
Practice Address - Street 1:807A S UNION AVE
Practice Address - Street 2:
Practice Address - City:HAVRE DE GRACE
Practice Address - State:MD
Practice Address - Zip Code:21078-3610
Practice Address - Country:US
Practice Address - Phone:410-939-2262
Practice Address - Fax:410-939-7119
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD145182251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD650020355OtherRAILROAD MEDICARE
MD391101200Medicaid
R12030Medicare UPIN
MD954L514EMedicare ID - Type Unspecified