Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 20849 | MD |
N | 2251X0800X | Physical Therapist - Orthopedic | 20849 | MD |
NPI | 1043499932 |
---|---|
Provider Name | Bryan W. Kreitlow |
First Address | Rockville, MD 20852-4216 |
Second Address | Rockville, MD 20852-4216 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/10/2007 |
Last Update Date | 29/10/2007 |