Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 146408 | MD |
NPI | 1003144379 |
---|---|
Provider Name | Kimberly Ann Cardosa |
First Address | Baltimore, MD 21207-6665 |
Second Address | Baltimore, MD 21207-6665 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/11/2009 |
Last Update Date | 25/11/2009 |