Healthcare Provider Details

I. General information

NPI: 1497223325
Provider Name (Legal Business Name): KATHLEEN QUAYLE SPECHT PT, M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2018
Last Update Date: 11/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4511 BESTOR DR
ROCKVILLE MD
20853-2100
US

IV. Provider business mailing address

4511 BESTOR DR
ROCKVILLE MD
20853-2100
US

V. Phone/Fax

Practice location:
  • Phone: 240-740-2150
  • Fax:
Mailing address:
  • Phone: 240-740-2150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number15492
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: