Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 28568 | MD |
NPI | 1477221885 |
---|---|
Provider Name | Daijah Proctor |
First Address | Upper Marlboro, MD 20774-9251 |
Second Address | Upper Marlboro, MD 20774-9251 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2021 |
Last Update Date | 31/08/2021 |