Individual
CLARISSA GOSNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7407 WILLOW RD, FREDERICK, MD 21702-2500
(301) 644-5600
Mailing address
2447 BRADDOCK RD, MOUNT AIRY, MD 21771-8801
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
A4361
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A4361
MARYLAND PT BOARD
MD
01
—
G-254-119-368-699
DRIVERS LICENSE
MD
Enumeration date
01/15/2019
Last updated
01/15/2019
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