Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 15517 | MD |
NPI | 1083753743 |
---|---|
Provider Name | Miss Loraine Frey |
First Address | Ellicott City, MD 21042-1771 |
Second Address | Towson, MD 21204-7673 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
400590-03 | BC BS (01) | MD |