Provider Demographics
NPI:1144651589
Name:ONTIVEROS, DANIEL RAFAEL (DPT)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:RAFAEL
Last Name:ONTIVEROS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12850 MIDDLEBROOK RD STE 307
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-5244
Mailing Address - Country:US
Mailing Address - Phone:301-972-4752
Mailing Address - Fax:301-972-4836
Practice Address - Street 1:12850 MIDDLEBROOK RD STE 307
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-5244
Practice Address - Country:US
Practice Address - Phone:301-972-4752
Practice Address - Fax:301-972-4836
Is Sole Proprietor?:No
Enumeration Date:2013-12-11
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25689225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY0KX9OtherFLORIDA BLUE
FLY0KX9OtherFLORIDA BLUE