Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | A2402 | MD |
NPI | 1003037482 |
---|---|
Provider Name | Kristen Ann Roden-Hicks |
First Address | Baltimore, MD 21211-1460 |
Second Address | Ellicott City, MD 21042-6314 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2007 |
Last Update Date | 04/09/2013 |