Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 21039 | MD |
N | 2251G0304X | Physical Therapist - Geriatrics | ||
N | 2251S0007X | Physical Therapist - Sports | ||
N | 2251X0800X | Physical Therapist - Orthopedic | 21039 | MD |
NPI | 1316197650 |
---|---|
Provider Name | Yordanos Gezai Michael |
First Address | College Park, MD 20740-1223 |
Second Address | College Park, MD 20740-1223 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2008 |
Last Update Date | 30/10/2020 |