MEDICARE: LOIS LYDIA BLY MA, 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	225100000X	Physical Therapist	17711	MD

General Provider Information

NPI Number	:	1902989510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOIS LYDIA BLY MA, PT

Provider Business Mailing Address
First Line	:	3504 BUCKS COUNTY CT
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-4143
Country	:	US
Telephone Number	:	410-418-9498
Fax Number	:	410-465-5285

Provider Business Practice Location Address
First Line	:	3504 BUCKS COUNTY CT
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-4143
Country	:	US
Telephone Number	:	410-418-9498
Fax Number	:	410-465-5285

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

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	07/08/2007

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