Healthcare Provider Details

I. General information

NPI: 1558671834
Provider Name (Legal Business Name): SARA L SCOVITCH MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SARA L ANNABLE MPT

II. Dates (important events)

Enumeration Date: 10/20/2010
Last Update Date: 10/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8965 GUILFORD RD SUITE 160
COLUMBIA MD
21046-2384
US

IV. Provider business mailing address

11027 HAUGHS CHURCH RD
KEYMAR MD
21757-8765
US

V. Phone/Fax

Practice location:
  • Phone: 301-706-3191
  • Fax:
Mailing address:
  • Phone: 301-845-6811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number19745
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: