Provider Demographics
NPI:1326710831
Name:GILLEGO CARADO, MARY ANN S (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MARY ANN
Middle Name:S
Last Name:GILLEGO CARADO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:MARY ANN
Other - Middle Name:
Other - Last Name:GILLEGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:135 WARWICK DR
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE-TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093
Mailing Address - Country:US
Mailing Address - Phone:443-201-4571
Mailing Address - Fax:
Practice Address - Street 1:2434 W BELVEDERE AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215
Practice Address - Country:US
Practice Address - Phone:410-601-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-03
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25782225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist