Provider Demographics
NPI:1992859516
Name:CATONSVILLE PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:CATONSVILLE PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ERMANNO
Authorized Official - Middle Name:R
Authorized Official - Last Name:COSTABILE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:410-747-8571
Mailing Address - Street 1:700 GEIPE RD SUITE 240
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228
Mailing Address - Country:US
Mailing Address - Phone:410-747-8571
Mailing Address - Fax:410-747-9050
Practice Address - Street 1:700 GEIPE RD SUITE 240
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228
Practice Address - Country:US
Practice Address - Phone:410-747-8571
Practice Address - Fax:410-747-9050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD189NMedicare ID - Type UnspecifiedPRACTICE PROVIDER NUMBER