Basic Information
| Provider Information | |||||||||
| NPI: | 1295452340 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | IMPERIO | ||||||||
| FirstName: | CALVIN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4810 RIVER CREEK TER | ||||||||
| Address2: | |||||||||
| City: | BELTSVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207055109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9417240273 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10750 COLUMBIA PIKE STE 401B | ||||||||
| Address2: | |||||||||
| City: | SILVER SPRING | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209014457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4435128337 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2022 | ||||||||
| LastUpdateDate: | 10/19/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.