Provider Demographics
NPI:1417355439
Name:NAMO, RAUL (PT)
Entity Type:Individual
Prefix:
First Name:RAUL
Middle Name:
Last Name:NAMO
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 1:9533 HICKORYHURST DR
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-4705
Mailing Address - Country:US
Mailing Address - Phone:443-682-3829
Mailing Address - Fax:
Practice Address - Street 1:9533 HICKORYHURST DR
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-4705
Practice Address - Country:US
Practice Address - Phone:443-682-3829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-08
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22632225100000X
MI5501013111225100000X
NM4074225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist