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General NPI Number Information
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NPI Number | 1184335200
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Entity Type | Individual
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Provider Name | CAMILLE LYNN GRACE DPT
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Gender | Female
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Dates
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Enumeration Date | 12/09/2022
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Last Update Date | 06/18/2025
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Provider Practice Location Address
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Address Line | 10700 CHARTER DR STE 205
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City | COLUMBIA
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State | MD
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Zip | 21044-3687
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Country | US
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Telephone | 443-546-1575
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Fax | 443-546-1575
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Provider Business Mailing Address
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Address Line | 6201 GREENLEIGH AVE
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City | MIDDLE RIVER
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State | MD
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Zip | 21220-2004
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Country | US
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Telephone |
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Fax | 720-497-6767
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 20481
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 30019
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License Number State | MD
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