Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | A2997 | MD |
NPI | 1003062191 |
---|---|
Provider Name | Mrs. Christine Roche |
First Address | Catonsville, MD 21228 |
Second Address | Catonsville, MD 21228 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2008 |
Last Update Date | 08/08/2008 |