Healthcare Provider Details

I. General information

NPI: 1154577179
Provider Name (Legal Business Name): AMY ELIZABETH PANNELL DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2008
Last Update Date: 06/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20500 SENECA MEADOWS PKWY
GERMANTOWN MD
20876-7008
US

IV. Provider business mailing address

20500 SENECA MEADOWS PKWY
GERMANTOWN MD
20876-7008
US

V. Phone/Fax

Practice location:
  • Phone: 301-916-8500
  • Fax: 301-528-6258
Mailing address:
  • Phone: 301-916-8500
  • Fax: 301-528-6258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberJ10002401
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number22998
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: