Healthcare Provider Details

I. General information

NPI: 1396039244
Provider Name (Legal Business Name): AMY CATHERINE IADAROLA CERTIFIED ROLFER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2011
Last Update Date: 06/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3938 LANTERN DR
SILVER SPRING MD
20902-2321
US

IV. Provider business mailing address

3938 LANTERN DR
SILVER SPRING MD
20902-2321
US

V. Phone/Fax

Practice location:
  • Phone: 301-908-7847
  • Fax:
Mailing address:
  • Phone: 301-908-7847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License NumberM04594
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: