Provider Demographics
NPI:1992349450
Name:VITAL, CITADEL
Entity type:Individual
Prefix:
First Name:CITADEL
Middle Name:
Last Name:VITAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 MILL POND LN APT 308
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-2115
Mailing Address - Country:US
Mailing Address - Phone:443-614-6479
Mailing Address - Fax:
Practice Address - Street 1:300 MILL POND LN APT 308
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-2115
Practice Address - Country:US
Practice Address - Phone:443-614-6479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-28
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24208225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist