MEDICARE: MRS. SANU MARY SEN PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	19134	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LX96	OTHER	MD	PT

General Provider Information

NPI Number	:	1275735847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SANU MARY SEN PT

Provider Business Mailing Address
First Line	:	109 HUNTS BLUFF RD
Second Line	:
City	:	SPARKS
State	:	MD
Zip	:	21152-9713
Country	:	US
Telephone Number	:	410-383-6665
Fax Number	:	410-383-6778

Provider Business Practice Location Address
First Line	:	734 W NORTH AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21217-4431
Country	:	US
Telephone Number	:	410-383-6665
Fax Number	:	410-383-6778

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2007
Last Update Date	:	07/09/2007

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Directions to “ MRS. SANU MARY SEN PT” Practice Location

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