Provider Demographics
NPI:1215122023
Name:RAMENTO-TIPON, LYDIA ABEJUELA (PT)
Entity type:Individual
Prefix:MRS
First Name:LYDIA
Middle Name:ABEJUELA
Last Name:RAMENTO-TIPON
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 1:630 CYPRESSPOINTE DR
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-4100
Mailing Address - Country:US
Mailing Address - Phone:410-518-6899
Mailing Address - Fax:410-518-6899
Practice Address - Street 1:630 CYPRESSPOINTE DR
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-4100
Practice Address - Country:US
Practice Address - Phone:410-518-6899
Practice Address - Fax:410-518-6899
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-14
Last Update Date:2008-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18244225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist