Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 17397 | MD |
NPI | 1003252396 |
---|---|
Provider Name | Tresa M Grasser |
First Address | Fallston, MD 21047-1213 |
Second Address | Belcamp, MD 21017-1452 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2013 |
Last Update Date | 14/05/2013 |