Healthcare Provider Details

I. General information

NPI: 1013070788
Provider Name (Legal Business Name): LAURA FLYNN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 01/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11085 LITTLE PATUXENT PKWY SUITE 207
COLUMBIA MD
21044-2983
US

IV. Provider business mailing address

11085 LITTLE PATUXENT PKWY SUITE 207
COLUMBIA MD
21044-2983
US

V. Phone/Fax

Practice location:
  • Phone: 410-884-4111
  • Fax: 410-884-4113
Mailing address:
  • Phone: 410-884-4111
  • Fax: 410-884-4113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number17374
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: