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General NPI Number Information
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NPI Number | 1619279551
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Entity Type | Organization
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Legal Business Name | HEALING AND WELLNESS CENTER OF KENT ISLAND
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Dates
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Enumeration Date | 11/29/2010
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Last Update Date | 11/29/2010
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Provider Practice Location Address
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Address Line | 711 MAIN ST
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City | STEVENSVILLE
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State | MD
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Zip | 21666-4011
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Country | US
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Telephone | 410-604-0900
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Fax | 410-604-0960
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Provider Business Mailing Address
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Address Line | 310 LISTMAN CT
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City | SEVERNA PARK
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State | MD
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Zip | 21146-1757
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Country | US
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Telephone | 410-604-0900
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. KRISTIN MIKELE MOWRY
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Credential | PT, DPT
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Telephone | 410-604-0900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 21949
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License Number State | MD
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