Healthcare Provider Details

I. General information

NPI: 1336747930
Provider Name (Legal Business Name): MELISSA WOHLBERG PT, DPT, RY200
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA WOHL

II. Dates (important events)

Enumeration Date: 10/15/2020
Last Update Date: 10/15/2020
Certification Date: 10/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 REISTERSTOWN RD STE 109
PIKESVILLE MD
21208-2978
US

IV. Provider business mailing address

1700 REISTERSTOWN RD STE 109
PIKESVILLE MD
21208-2978
US

V. Phone/Fax

Practice location:
  • Phone: 410-908-5595
  • Fax:
Mailing address:
  • Phone: 410-908-5595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number22484
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number22484
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: