Basic Information
| Provider Information | |||||||||
| NPI: | 1568478675 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARITATO | ||||||||
| FirstName: | ANTHONY | ||||||||
| MiddleName: | J. | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20 OVERBROOK DR | ||||||||
| Address2: | SUITE D | ||||||||
| City: | MONROE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450503101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5134209999 | ||||||||
| FaxNumber: | 8774307975 | ||||||||
| Practice Location | |||||||||
| Address1: | 20 OVERBROOK DR | ||||||||
| Address2: | SUITE D | ||||||||
| City: | MONROE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450503101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135392886 | ||||||||
| FaxNumber: | 8774307975 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2006 | ||||||||
| LastUpdateDate: | 01/23/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT22751 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | PT011602 | OH | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 2723379 | 05 | OH | MEDICAID | PT22751 | 01 | FL | STATE LICENSE | OTHER | PT 011602 | 01 | OH | LICENSE NUMBER | OTHER |