Provider Demographics
NPI:1821116690
Name:SHIDERLY, RONALD (MPT)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:SHIDERLY
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8836 LYNCH DR
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:MD
Mailing Address - Zip Code:21875-2451
Mailing Address - Country:US
Mailing Address - Phone:410-603-3540
Mailing Address - Fax:
Practice Address - Street 1:200 CIVIC AVE
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-4599
Practice Address - Country:US
Practice Address - Phone:410-749-1466
Practice Address - Fax:410-749-9264
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18035225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist