Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 18280 | MD |
NPI | 1073600789 |
---|---|
Provider Name | Mrs. Kelly Ann Runfola |
First Address | Lutherville, MD 21093-3312 |
Second Address | Glen Burnie, MD 21061-5577 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2006 |
Last Update Date | 08/07/2007 |