Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | A2721 | MD |
NPI | 1013560853 |
---|---|
Provider Name | Janine Brown |
First Address | Columbia, MD 21044-2559 |
Second Address | Ellicott City, MD 21042-7831 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2019 |
Last Update Date | 22/07/2019 |