Healthcare Provider Details

I. General information

NPI: 1912988858
Provider Name (Legal Business Name): GAIL ROVAN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

914 WASHINGTON RD D
WESTMINSTER MD
21157-5844
US

IV. Provider business mailing address

6411 WHITE ROCK RD
SYKESVILLE MD
21784-8146
US

V. Phone/Fax

Practice location:
  • Phone: 410-848-1722
  • Fax: 410-569-5121
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number16881
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: