Healthcare Provider Details

I. General information

NPI: 1366723785
Provider Name (Legal Business Name): MAUREEN ANN SAWYER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2011
Last Update Date: 08/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17908 BARNEY DR
ACCOKEEK MD
20607-3234
US

IV. Provider business mailing address

17908 BARNEY DR
ACCOKEEK MD
20607-3234
US

V. Phone/Fax

Practice location:
  • Phone: 240-423-9547
  • Fax: 301-283-6940
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number4561
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: