Healthcare Provider Details

I. General information

NPI: 1679071278
Provider Name (Legal Business Name): ELIZABETH ANNE HATCH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2018
Last Update Date: 01/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11711 GALT AVE
SILVER SPRING MD
20902-2709
US

IV. Provider business mailing address

11711 GALT AVE
SILVER SPRING MD
20902-2709
US

V. Phone/Fax

Practice location:
  • Phone: 713-410-0428
  • Fax:
Mailing address:
  • Phone: 713-410-0428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number20789
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number20789
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: