Individual
ALEXANDRA DEPTULA MANURUNG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, LAT, ATC, PTA
Contact information
Practice address
715 CARTER RD, ROCKVILLE, MD 20852-1006
(410) 340-1046
Mailing address
715 CARTER RD, ROCKVILLE, MD 20852-1006
(410) 340-1046
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
A4337
MD
2255A2300X
Athletic Trainer
A00208
MD
Other
Enumeration date
06/07/2014
Last updated
04/15/2021
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