Provider Demographics
NPI:1558538488
Name:RELATIVO, PHILIP FRANCIS MALAYA (PT)
Entity Type:Individual
Prefix:
First Name:PHILIP FRANCIS
Middle Name:MALAYA
Last Name:RELATIVO
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 1:1433 ILLINOIS AVE
Mailing Address - Street 2:
Mailing Address - City:SEVERN
Mailing Address - State:MD
Mailing Address - Zip Code:21144-2641
Mailing Address - Country:US
Mailing Address - Phone:410-330-4534
Mailing Address - Fax:
Practice Address - Street 1:1433 ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:SEVERN
Practice Address - State:MD
Practice Address - Zip Code:21144-2641
Practice Address - Country:US
Practice Address - Phone:410-330-4534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-09
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22545225100000X
NY029126225100000X
PA019433225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist