Healthcare Provider Details

I. General information

NPI: 1881794527
Provider Name (Legal Business Name): MARY ELLEN HARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 N GREENE ST
BALTIMORE MD
21201-1524
US

IV. Provider business mailing address

720 WHEATLEY RD
NORTH EAST MD
21901-2028
US

V. Phone/Fax

Practice location:
  • Phone: 410-642-2411
  • Fax:
Mailing address:
  • Phone: 410-398-1914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code226300000X
TaxonomyKinesiotherapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: