=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851593875
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DORRINE GARDIPEE PTA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/01/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11308 BIG HORN CT
-----------------------------------------------------
City | BELTSVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20705-1428
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-576-6387
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11308 BIG HORN CT
-----------------------------------------------------
City | BELTSVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20705-1428
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-576-6387
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225200000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Assistant
-----------------------------------------------------
License Number | A3005
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------