Healthcare Provider Details

I. General information

NPI: 1619259991
Provider Name (Legal Business Name): RADHIKA DEEPAK TALIM PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2011
Last Update Date: 12/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 THIRD AVE
SYKESVILLE MD
21784-5201
US

IV. Provider business mailing address

7200 THIRD AVE
SYKESVILLE MD
21784-5201
US

V. Phone/Fax

Practice location:
  • Phone: 410-795-8800
  • Fax:
Mailing address:
  • Phone: 410-795-8800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number032584
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number24022
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: