Provider Demographics
NPI:1548510654
Name:NEWVILLAMOR, KAREEN BN (PT)
Entity type:Individual
Prefix:
First Name:KAREEN
Middle Name:BN
Last Name:NEWVILLAMOR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2222
Mailing Address - Fax:630-759-9510
Practice Address - Street 1:18749 N FREDERICK AVE
Practice Address - Street 2:STE I & J
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-3165
Practice Address - Country:US
Practice Address - Phone:301-916-8540
Practice Address - Fax:301-916-8476
Is Sole Proprietor?:No
Enumeration Date:2012-09-17
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24152225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD8825 - 0014OtherCAREFIRST