Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 24092 | MD |
N | 2251X0800X | Physical Therapist - Orthopedic | 24092 | MD |
NPI | 1053795054 |
---|---|
Provider Name | Dat Ba Quach |
First Address | Annapolis, MD 21401-3742 |
Second Address | Annapolis, MD 21401-3742 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2015 |
Last Update Date | 20/07/2015 |