Provider Demographics
NPI:1376979567
Name:CICMIL, BORISLAV (DPT)
Entity Type:Individual
Prefix:
First Name:BORISLAV
Middle Name:
Last Name:CICMIL
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7811 MONTROSE RD STE 340
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-3363
Mailing Address - Country:US
Mailing Address - Phone:301-588-7888
Mailing Address - Fax:301-588-3419
Practice Address - Street 1:7811 MONTROSE RD STE 340
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-3363
Practice Address - Country:US
Practice Address - Phone:301-588-7888
Practice Address - Fax:301-588-3419
Is Sole Proprietor?:No
Enumeration Date:2013-09-19
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24706225100000X
VA2305208226225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD24706OtherMD BOARD OF PT EXAMINERS