Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist |
NPI | 1881794527 |
---|---|
Provider Name | Mary Ellen Harris |
First Address | North East, MD 21901-2028 |
Second Address | Baltimore, MD 21201-1524 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2006 |
Last Update Date | 08/07/2007 |