Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 030112 | NY |
NPI | 1003040791 |
---|---|
Provider Name | Susannah Lynn Coover |
First Address | Columbia, MD 21045-2199 |
Second Address | Columbia, MD 21045-2199 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2009 |
Last Update Date | 30/03/2021 |