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1104805985

NPI Code Detail

MEDICARE: MRS. VIRGINIA MARIE STANDFORD MSPT

MEDICARE: MRS. VIRGINIA MARIE STANDFORD MSPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	18657	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	K1340002	OTHER	MD	CAP/FED BC
2	602030700	OTHER	MD	DEPT OF LABOR MSS
3	R5590003	OTHER	MD	FSS CAP BC
4	147719000	OTHER	MD	DEPT OF LABOR
5	546240-06	OTHER	MD	CAREFIRST FSS
6	54624007	OTHER	MD	MSS BC

General Provider Information

NPI Number	:	1104805985
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VIRGINIA MARIE STANDFORD MSPT

Provider Business Mailing Address
First Line	:	9007 GRAPE CREEK RD
Second Line	:
City	:	WALKERSVILLE
State	:	MD
Zip	:	21793-8808
Country	:	US
Telephone Number	:	301-845-7289
Fax Number	:	240-215-9026

Provider Business Practice Location Address
First Line	:	610 SOLAREX CT
Second Line	:
City	:	FREDERICK
State	:	MD
Zip	:	21703-8624
Country	:	US
Telephone Number	:	240-215-9023
Fax Number	:	240-215-9026

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2006
Last Update Date	:	09/15/2010

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Directions to “ MRS. VIRGINIA MARIE STANDFORD MSPT” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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