Individual
DARRYL GOTWALT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
200 HOSPITAL DR STE 506A, GLEN BURNIE, MD 21061-5887
(410) 768-5558
Mailing address
7109 YORK RD, BALTIMORE, MD 21212-1526
(410) 337-7705
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
17450
LICENSE #
MD
Enumeration date
08/30/2006
Last updated
07/08/2007
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