Healthcare Provider Details

I. General information

NPI: 1770929085
Provider Name (Legal Business Name): MARY KATE FISCHER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2013
Last Update Date: 05/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 EMMERICK DR
JOPPA MD
21085-3732
US

IV. Provider business mailing address

1012 EMMERICK DR
JOPPA MD
21085-3732
US

V. Phone/Fax

Practice location:
  • Phone: 410-679-0330
  • Fax:
Mailing address:
  • Phone: 410-679-0330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA1835
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: