Provider Demographics
NPI:1649599341
Name:FELISILDA, MICHAEL TANO (PT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:TANO
Last Name:FELISILDA
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 1:9600 GROVETON CIR
Mailing Address - Street 2:APT. T1
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-8300
Mailing Address - Country:US
Mailing Address - Phone:706-897-5835
Mailing Address - Fax:
Practice Address - Street 1:9047 SHADY GROVE CT
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-1301
Practice Address - Country:US
Practice Address - Phone:706-897-5835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-20
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT009014225100000X
MD23559225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist