Healthcare Provider Details

I. General information

NPI: 1326633975
Provider Name (Legal Business Name): MRUNMAYEE GHATE PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2021
Last Update Date: 05/20/2022
Certification Date: 05/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3311 TOLEDO TER STE A1
HYATTSVILLE MD
20782-4136
US

IV. Provider business mailing address

14205 PARK CENTER DR STE 204
LAUREL MD
20707-5252
US

V. Phone/Fax

Practice location:
  • Phone: 301-853-0093
  • Fax:
Mailing address:
  • Phone: 301-853-0093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number28154
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305214850
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: