Provider Demographics
NPI:1548714074
Name:DIZON, ROMMER UYBUNGCO (PT)
Entity type:Individual
Prefix:MR
First Name:ROMMER
Middle Name:UYBUNGCO
Last Name:DIZON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:MR
Other - First Name:ROMMER-ERNESTO
Other - Middle Name:UYBUNGCO
Other - Last Name:DIZON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:390 WILETT CT
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-1912
Mailing Address - Country:US
Mailing Address - Phone:620-203-1934
Mailing Address - Fax:
Practice Address - Street 1:545 BALTIMORE ANNAPOLIS BLVD
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-3809
Practice Address - Country:US
Practice Address - Phone:410-315-9080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-12
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD26066225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist