Healthcare Provider Details

I. General information

NPI: 1710226014
Provider Name (Legal Business Name): MRS. JOSEPHINE DAVID BAGSIC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2013
Last Update Date: 02/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9735 WYNDHAM DR
FREDERICK MD
21704-7391
US

IV. Provider business mailing address

9735 WYNDHAM DR
FREDERICK MD
21704-7391
US

V. Phone/Fax

Practice location:
  • Phone: 240-575-4289
  • Fax:
Mailing address:
  • Phone: 240-575-4289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number21926
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: