MEDICARE: DANIEL RAFAEL ONTIVEROS DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	25689	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Y0KX9	OTHER	FL	FLORIDA BLUE

General Provider Information

NPI Number	:	1144651589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL RAFAEL ONTIVEROS DPT

Provider Business Mailing Address
First Line	:	12850 MIDDLEBROOK RD STE 307
Second Line	:
City	:	GERMANTOWN
State	:	MD
Zip	:	20874-5244
Country	:	US
Telephone Number	:	301-972-4752
Fax Number	:	301-972-4836

Provider Business Practice Location Address
First Line	:	12850 MIDDLEBROOK RD STE 307
Second Line	:
City	:	GERMANTOWN
State	:	MD
Zip	:	20874-5244
Country	:	US
Telephone Number	:	301-972-4752
Fax Number	:	301-972-4836

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2013
Last Update Date	:	11/25/2020

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