Provider Demographics
NPI:1285620864
Name:VALENTINO, KATHLEEN KEYS (PT)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:KEYS
Last Name:VALENTINO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:KEYS
Other - Last Name:MCFADDEN-VALENTINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:659 S SALISBURY BLVD STE 1B
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-5458
Mailing Address - Country:US
Mailing Address - Phone:410-831-3226
Mailing Address - Fax:410-677-0883
Practice Address - Street 1:598 CYNWOOD DR STE 101
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-3875
Practice Address - Country:US
Practice Address - Phone:410-770-9720
Practice Address - Fax:410-770-9725
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16474225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1107366OtherFIRST HEALTH NETWORK
522052340OtherPHCS
147433401OtherUS DEPT OF LABOR
MD526617-07OtherBCBS OF MD
DCT6710005OtherBCBS OF DC
MD526617-07OtherBCBS OF MD