Healthcare Provider Details

I. General information

NPI: 1255002564
Provider Name (Legal Business Name): EDEN DANIELLE ORZECH PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2021
Last Update Date: 09/26/2021
Certification Date: 09/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 POT SPRING RD
LUTHERVILLE MD
21093-2778
US

IV. Provider business mailing address

20 DEER CROSS CT
REISTERSTOWN MD
21136-5907
US

V. Phone/Fax

Practice location:
  • Phone: 410-561-0200
  • Fax:
Mailing address:
  • Phone: 443-851-0767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA4879
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: