Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 25483 | MD |
NPI | 1003295510 |
---|---|
Provider Name | Alyssa Alexander |
First Address | Catonsville, MD 21228-4516 |
Second Address | Eldersburg, MD 21784 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2015 |
Last Update Date | 20/11/2018 |