Basic Information
Provider Information | |||||||||
NPI: | 1285620864 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | VALENTINO | ||||||||
FirstName: | KATHLEEN | ||||||||
MiddleName: | KEYS | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | PT | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | MCFADDEN-VALENTINO | ||||||||
OtherFirstName: | KATHLEEN | ||||||||
OtherMiddleName: | KEYS | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 659 S SALISBURY BLVD STE 1B | ||||||||
Address2: |   | ||||||||
City: | SALISBURY | ||||||||
State: | MD | ||||||||
PostalCode: | 218015458 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4108313226 | ||||||||
FaxNumber: | 4106770883 | ||||||||
Practice Location | |||||||||
Address1: | 598 CYNWOOD DR STE 101 | ||||||||
Address2: |   | ||||||||
City: | EASTON | ||||||||
State: | MD | ||||||||
PostalCode: | 216013875 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4107709720 | ||||||||
FaxNumber: | 4107709725 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/20/2005 | ||||||||
LastUpdateDate: | 04/23/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 16474 | MD | Y |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |   |
ID Information
ID | Type | State | Issuer | Description | 1107366 | 01 |   | FIRST HEALTH NETWORK | OTHER | 522052340 | 01 |   | PHCS | OTHER | 147433401 | 01 |   | US DEPT OF LABOR | OTHER | 526617-07 | 01 | MD | BCBS OF MD | OTHER | T6710005 | 01 | DC | BCBS OF DC | OTHER |