Healthcare Provider Details

I. General information

NPI: 1902651185
Provider Name (Legal Business Name): AMY LEBHERZ DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2024
Last Update Date: 04/20/2024
Certification Date: 04/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7130 MINSTREL WAY STE 160
COLUMBIA MD
21045-5336
US

IV. Provider business mailing address

109 FOREST DR
CATONSVILLE MD
21228-5119
US

V. Phone/Fax

Practice location:
  • Phone: 410-312-9922
  • Fax:
Mailing address:
  • Phone: 443-904-5981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number17672
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: