Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 24960 | MD |
NPI | 1003220229 |
---|---|
Provider Name | Kelly Marie Hanns |
First Address | Rockville, MD 20852 |
Second Address | Rockville, MD 20852 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2014 |
Last Update Date | 16/06/2014 |