Healthcare Provider Details

I. General information

NPI: 1295875979
Provider Name (Legal Business Name): HEATHER D NITSCH DPT, OCS, CHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 06/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 FRONT AVE SUITE 205
LUTHERVILLE MD
21093-5300
US

IV. Provider business mailing address

676 HUNTING FIELDS RD
BALTIMORE MD
21220-2325
US

V. Phone/Fax

Practice location:
  • Phone: 410-823-4263
  • Fax: 410-823-1861
Mailing address:
  • Phone: 410-458-6753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number20000
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2251H1200X
TaxonomyHand Physical Therapist
License Number20000
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: