Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 24787 | MD |
NPI | 1255733929 |
---|---|
Provider Name | Miss Randi Michelle Clary |
First Address | Baltimore, MD 21207 |
Second Address | Baltimore, MD 21207 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2014 |
Last Update Date | 24/09/2014 |