Provider Demographics
NPI:1568478675
Name:MARITATO, ANTHONY J (PT)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:J
Last Name:MARITATO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 OVERBROOK DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:MONROE
Mailing Address - State:OH
Mailing Address - Zip Code:45050-3101
Mailing Address - Country:US
Mailing Address - Phone:513-420-9999
Mailing Address - Fax:877-430-7975
Practice Address - Street 1:20 OVERBROOK DR
Practice Address - Street 2:SUITE D
Practice Address - City:MONROE
Practice Address - State:OH
Practice Address - Zip Code:45050-3101
Practice Address - Country:US
Practice Address - Phone:513-539-2886
Practice Address - Fax:877-430-7975
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT22751225100000X
OHPT011602225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2723379Medicaid
FLPT22751OtherSTATE LICENSE
OHPT 011602OtherLICENSE NUMBER
OHH012030Medicare UPIN
FLU8449YMedicare UPIN