Provider Demographics
NPI:1790778181
Name:MOUNTCASTLE, ROBERT BRADLEY (ATC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:BRADLEY
Last Name:MOUNTCASTLE
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4288 WOLF HILL DR
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:MD
Mailing Address - Zip Code:21074-2009
Mailing Address - Country:US
Mailing Address - Phone:410-493-8156
Mailing Address - Fax:
Practice Address - Street 1:4288 WOLF HILL DR
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:MD
Practice Address - Zip Code:21074-2009
Practice Address - Country:US
Practice Address - Phone:410-493-8156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer