Healthcare Provider Details

I. General information

NPI: 1548714074
Provider Name (Legal Business Name): ROMMER ERNESTO DIZON PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ROMMER DIZON PT, DPT

II. Dates (important events)

Enumeration Date: 08/12/2016
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8651 FORT SMALLWOOD RD STE 1
PASADENA MD
21122-2445
US

IV. Provider business mailing address

390 WILETT CT
SEVERNA PARK MD
21146-1912
US

V. Phone/Fax

Practice location:
  • Phone: 443-938-2718
  • Fax: 443-645-2567
Mailing address:
  • Phone: 620-203-1934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number26066
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: