Healthcare Provider Details

I. General information

NPI: 1932205424
Provider Name (Legal Business Name): WRAY PARDY PIANTA MMSC PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 07/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6605 FOX MEADE CT
FREDERICK MD
21702-9493
US

IV. Provider business mailing address

6605 FOX MEADE CT
FREDERICK MD
21702-9493
US

V. Phone/Fax

Practice location:
  • Phone: 301-698-9681
  • Fax:
Mailing address:
  • Phone: 301-698-9681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number19241
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: