Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | A2715 | MD |
NPI | 1013304872 |
---|---|
Provider Name | Danielle Polk |
First Address | Cumberland, MD 21502-2908 |
Second Address | Baltimore, MD 21202-2618 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2015 |
Last Update Date | 20/04/2015 |