Individual
MRS. ELLEN KRISTEN GUSTAFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
1311 S MAIN ST, SUITE 204, MOUNT AIRY, MD 21771-5447
(301) 607-9096
Mailing address
1311 S MAIN ST, SUITE 204, MOUNT AIRY, MD 21771-5447
(301) 607-9096
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
24213
MD
225100000X
Physical Therapist
PT 60255109
WA
Other
Enumeration date
01/12/2012
Last updated
11/14/2012
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