Individual
DEXTER PAMATIGAN VIDENA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
3290 N RIDGE RD, SUITE 290, ELLICOTT CITY, MD 21043-3655
(410) 750-9006
Mailing address
3264 KAISER DR, ELLICOTT CITY, MD 21043-4555
(410) 608-2912
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
22673
MD
Other
Enumeration date
10/26/2008
Last updated
10/26/2008
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