MEDICARE: MISS PATRENA LYNETTE CALDWELL P.T

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	18087	MD

General Provider Information

NPI Number	:	1306917463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS PATRENA LYNETTE CALDWELL P.T

Provider Business Mailing Address
First Line	:	9 SUMMERSET CT
Second Line	:
City	:	GWYNN OAK
State	:	MD
Zip	:	21207-8108
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9 SUMMERSET CT
Second Line	:
City	:	GWYNN OAK
State	:	MD
Zip	:	21207-8108
Country	:	US
Telephone Number	:	410-484-1001
Fax Number	:

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

Provider Enumeration Date	:	11/12/2006
Last Update Date	:	07/08/2007

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