Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 20617 | MD |
NPI | 1073081337 |
---|---|
Provider Name | Thu-Ha Devlin |
First Address | Gaithersburg, MD 20877-2037 |
Second Address | Germantown, MD 20876-4127 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2018 |
Last Update Date | 05/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
20617 | MARYLAND BOARD OF PHYSICAL THERAPY (01) | MD |