Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251P0200X | Physical Therapist - Pediatrics | 12152 | CA |
Y | 2251P0200X | Physical Therapist - Pediatrics | 16312 | MD |
N | 2251P0200X | Physical Therapist - Pediatrics | 5501001231 | MI |
NPI | 1003063645 |
---|---|
Provider Name | Ms. Susan Kay Dubroff |
First Address | Baltimore, MD 21209-4545 |
Second Address | Baltimore, MD 21209-4545 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2008 |
Last Update Date | 26/08/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
463100500 | (05) | MD |