Healthcare Provider Details

I. General information

NPI: 1528101631
Provider Name (Legal Business Name): MARY ROSE TOVORNIK ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 CAMDEN AVE
SALISBURY MD
21801-6860
US

IV. Provider business mailing address

1009 ZIRCON CT
SALISBURY MD
21804-8726
US

V. Phone/Fax

Practice location:
  • Phone: 410-677-0138
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT003628
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberA0000775
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: