Provider Demographics
NPI:1386052835
Name:SPELTA, JOSEPH (ATC)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:SPELTA
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6405 SEDGWICK ST
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-6198
Mailing Address - Country:US
Mailing Address - Phone:301-214-8608
Mailing Address - Fax:310-493-5905
Practice Address - Street 1:10900 ROCKVILLE PIKE
Practice Address - Street 2:
Practice Address - City:NORTH BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20852-3209
Practice Address - Country:US
Practice Address - Phone:301-214-8608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00001052255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer