Provider Demographics
NPI:1851394977
Name:SCIBILIA, GERARD JOSEPH (MPT)
Entity Type:Individual
Prefix:MR
First Name:GERARD
Middle Name:JOSEPH
Last Name:SCIBILIA
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 1:910 FREDERICK RD
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4516
Mailing Address - Country:US
Mailing Address - Phone:410-644-1880
Mailing Address - Fax:410-646-3623
Practice Address - Street 1:910 FREDERICK RD
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-4516
Practice Address - Country:US
Practice Address - Phone:410-644-1880
Practice Address - Fax:410-646-3623
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3301225100000X, 2251H1200X, 2251N0400X, 2251X0800X
SC3992255A2300X
MD23300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHand
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ322337747Medicare ID - Type UnspecifiedGROUP PRACTICE