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NPI Code Detail

MEDICARE: LORI ANN KETLER PT

MEDICARE: LORI ANN KETLER 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
1225100000XPhysical Therapist16676MD

General Provider Information

NPI Number : 1932387560
Entity Type Code : Individual
Provider Name (Legal Business Name) : LORI ANN KETLER PT
Provider Business Mailing Address
First Line : PO BOX 4058
Second Line :
City : CROFTON
State : MD
Zip : 21114-4058
Country : US
Telephone Number : 301-498-2212
Fax Number : 301-498-2213
Provider Business Practice Location Address
First Line : 100 WHITE MARSH PARK DR
Second Line :
City : BOWIE
State : MD
Zip : 20715-4361
Country : US
Telephone Number : 301-262-5852
Fax Number : 301-262-3173
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/06/2008
Last Update Date : 10/04/2022

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Directions to “ LORI ANN KETLER PT” Practice Location

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