Healthcare Provider Details

I. General information

NPI: 1982159158
Provider Name (Legal Business Name): SARAH ELIZABETH NESSEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2016
Last Update Date: 01/16/2024
Certification Date: 01/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 HOSPITAL RD STE 103
PRINCE FREDERICK MD
20678
US

IV. Provider business mailing address

100 HOSPITAL RD ATTN: CONTRACTING & CREDENTIALING COORDINATOR
PRINCE FREDERICK MD
20678
US

V. Phone/Fax

Practice location:
  • Phone: 410-535-8180
  • Fax: 410-535-8325
Mailing address:
  • Phone: 410-414-4791
  • Fax: 410-535-8417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number2305208191
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number26859
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: