Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251P0200X | Physical Therapist - Pediatrics | 2305206539 | VA |
Y | 2251P0200X | Physical Therapist - Pediatrics | 23294 | MD |
NPI | 1114230521 |
---|---|
Provider Name | Mrs. Kelly A Fox |
First Address | Elkridge, MD 21075-6595 |
Second Address | Elkridge, MD 21075-6595 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2010 |
Last Update Date | 28/10/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2305206539 | VIRGINIA BOARD OF PHYSICAL THERAPY (01) | VA |
23294 | MARYLAND STATE BOARD OF PHYSICAL THERAPY (01) | MD |