Provider Demographics
NPI:1518302751
Name:PANTILO, ANGELA PETRACORTA (PT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:PETRACORTA
Last Name:PANTILO
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 1:3621 SEWELL RD
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:MD
Mailing Address - Zip Code:21009-1222
Mailing Address - Country:US
Mailing Address - Phone:443-793-6767
Mailing Address - Fax:
Practice Address - Street 1:3621 SEWELL RD
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:MD
Practice Address - Zip Code:21009-1222
Practice Address - Country:US
Practice Address - Phone:443-793-6767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-01
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT022348225100000X
MD25809225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist