Provider Demographics
NPI:1518453539
Name:HATHWAY, DENZIL RICHARD (PT)
Entity Type:Individual
Prefix:
First Name:DENZIL
Middle Name:RICHARD
Last Name:HATHWAY
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 1:8224 DANIELS PURCHASE WAY
Mailing Address - Street 2:
Mailing Address - City:MILLERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21108-1598
Mailing Address - Country:US
Mailing Address - Phone:410-591-0790
Mailing Address - Fax:
Practice Address - Street 1:1217 W FAYETTE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21223-1938
Practice Address - Country:US
Practice Address - Phone:410-727-3947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-02
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20426225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist