Provider Demographics
NPI:1700066826
Name:OBIAS, PERCIVAL (PT)
Entity Type:Individual
Prefix:MR
First Name:PERCIVAL
Middle Name:
Last Name:OBIAS
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 1:3290 N. RIDGE RD., EXEC. CENTER II
Mailing Address - Street 2:SUITE 290
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-3655
Mailing Address - Country:US
Mailing Address - Phone:410-750-9006
Mailing Address - Fax:410-750-0787
Practice Address - Street 1:3201 W. COMMERCIAL BLVD.
Practice Address - Street 2:SUITE 116
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-3440
Practice Address - Country:US
Practice Address - Phone:954-739-4247
Practice Address - Fax:866-422-6431
Is Sole Proprietor?:No
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028909225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist