Healthcare Provider Details

I. General information

NPI: 1497755300
Provider Name (Legal Business Name): MARY THORSEN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 W FREDERICK ST
WALKERSVILLE MD
21793-8230
US

IV. Provider business mailing address

731 BALTIMORE BLVD
WESTMINSTER MD
21157-6105
US

V. Phone/Fax

Practice location:
  • Phone: 301-845-0045
  • Fax: 301-845-0045
Mailing address:
  • Phone: 410-848-8628
  • Fax: 410-848-3909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number17003
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: