Provider Demographics
NPI:1841565454
Name:RAGUDO, JOHN SOLIVEN (PT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:SOLIVEN
Last Name:RAGUDO
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 1:744 CAMBERLEY CIR
Mailing Address - Street 2:APT T1
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-3868
Mailing Address - Country:US
Mailing Address - Phone:410-790-0953
Mailing Address - Fax:
Practice Address - Street 1:744 CAMBERLEY CIR
Practice Address - Street 2:APT T1
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-3868
Practice Address - Country:US
Practice Address - Phone:410-790-0953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-14
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22033225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD316739ZU95Medicare PIN