MEDICARE: MARYELLEN DAVIS

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	2305213800	VA
2	225100000X	Physical Therapist	28083	MD

General Provider Information

NPI Number	:	1942177472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARYELLEN DAVIS

Provider Business Mailing Address
First Line	:	55 S RITTERS LN
Second Line	:
City	:	OWINGS MILLS
State	:	MD
Zip	:	21117-3336
Country	:	US
Telephone Number	:	571-226-0177
Fax Number	:

Provider Business Practice Location Address
First Line	:	1141 SUNRISE BEACH RD
Second Line	:
City	:	CROWNSVILLE
State	:	MD
Zip	:	21032-1126
Country	:	US
Telephone Number	:	410-923-6800
Fax Number	:

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

Provider Enumeration Date	:	10/20/2025
Last Update Date	:	10/20/2025

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Directions to “ MARYELLEN DAVIS ” Practice Location

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