Provider Demographics
NPI:1457500415
Name:MERJUDIO, RODELYN DATARIO (PT)
Entity Type:Individual
Prefix:MRS
First Name:RODELYN
Middle Name:DATARIO
Last Name:MERJUDIO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3290 N RIDGE RD
Mailing Address - Street 2:SUITE 290
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-3655
Mailing Address - Country:US
Mailing Address - Phone:703-435-5110
Mailing Address - Fax:
Practice Address - Street 1:719 MAIN ST
Practice Address - Street 2:APT 1
Practice Address - City:AKRON
Practice Address - State:PA
Practice Address - Zip Code:17501-1372
Practice Address - Country:US
Practice Address - Phone:443-538-7951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-15
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT019302225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist