Healthcare Provider Details

I. General information

NPI: 1902409238
Provider Name (Legal Business Name): CARL JOSHUA C CAMARILLO DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2020
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3084 WALDORF MARKET PL
WALDORF MD
20603-4872
US

IV. Provider business mailing address

3084 WALDORF MARKET PL
WALDORF MD
20603-4872
US

V. Phone/Fax

Practice location:
  • Phone: 240-530-8188
  • Fax: 301-638-0470
Mailing address:
  • Phone: 240-530-8188
  • Fax: 301-638-0470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number28152
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: