Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 14896 | MD |
Y | 2251P0200X | Physical Therapist - Pediatrics | 14896 | MD |
NPI | 1134699564 |
---|---|
Provider Name | Teri Knowles |
First Address | Ellicott City, MD 21042-6106 |
Second Address | Ellicott City, MD 21042-6106 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2018 |
Last Update Date | 28/11/2018 |