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NPI Code Detail

MEDICARE: KATHERINE CHILDERS

MEDICARE: KATHERINE CHILDERS
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
1225100000XPhysical Therapist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
120176OTHERMDLICENSE #

General Provider Information

NPI Number : 1568554764
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHERINE CHILDERS
Provider Business Mailing Address
First Line : 1517 HORNBEAM DR
Second Line :
City : CROFTON
State : MD
Zip : 21114-3244
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1651 CROFTON BLVD STE 14
Second Line :
City : CROFTON
State : MD
Zip : 21114-1314
Country : US
Telephone Number : 410-721-6650
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/28/2006
Last Update Date : 07/08/2007

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Directions to “ KATHERINE CHILDERS ” Practice Location

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