Healthcare Provider Details

I. General information

NPI: 1427816248
Provider Name (Legal Business Name): SABRINA GYSEGEM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2024
Last Update Date: 01/01/2025
Certification Date: 01/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8141 RITCHIE HWY #A
PASADENA MD
21122
US

IV. Provider business mailing address

314 6TH AVE NE
GLEN BURNIE MD
21060-6826
US

V. Phone/Fax

Practice location:
  • Phone: 443-906-0181
  • Fax:
Mailing address:
  • Phone: 443-818-0343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA5950
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: