Provider Demographics
NPI:1699282384
Name:GRADER, ROBERT SAMUEL (PTA)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:SAMUEL
Last Name:GRADER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10753 FALLS RD STE 235
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-4597
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:410-847-3838
Practice Address - Street 1:1132 ANNAPOLIS RD STE 101
Practice Address - Street 2:
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113-1672
Practice Address - Country:US
Practice Address - Phone:410-874-1700
Practice Address - Fax:410-874-1707
Is Sole Proprietor?:No
Enumeration Date:2018-01-04
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA4749225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant