Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 21100 | MD |
NPI | 1083930481 |
---|---|
Provider Name | Mrs. Amanda Lynne Krywonis |
First Address | Baltimore, MD 21230-4301 |
Second Address | Baltimore, MD 21207-6665 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2010 |
Last Update Date | 12/04/2010 |