Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | A4345 | MD |
NPI | 1013384783 |
---|---|
Provider Name | Karen Mattes |
First Address | Baltimore, MD 21211-3027 |
Second Address | Towson, MD 21204-7513 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2015 |
Last Update Date | 28/08/2015 |