Provider Demographics
NPI:1750413837
Name:MICHAEL CARUSO PT PA
Entity type:Organization
Organization Name:MICHAEL CARUSO PT PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LEON
Authorized Official - Last Name:CARUSO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:410-418-4060
Mailing Address - Street 1:PO BOX 618
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:MD
Mailing Address - Zip Code:20777-0618
Mailing Address - Country:US
Mailing Address - Phone:410-418-4060
Mailing Address - Fax:443-407-4466
Practice Address - Street 1:RT 108 AND RT 216 (B.618)
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:MD
Practice Address - Zip Code:20777
Practice Address - Country:US
Practice Address - Phone:410-418-4060
Practice Address - Fax:443-407-4466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15253225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD35032204OtherCAREFIRST PPO
G0021OtherWORKER'S COMP
MDH807OtherCAREFIRST HMO
MD2662648OtherAETNA HMO
MD4401432OtherAETNA PPO