Individual
LEA NINA ILORETA DAUZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
3264 KAISER DR, ELLICOTT CITY, MD 21043-4555
(410) 660-5924
Mailing address
3264 KAISER DR, ELLICOTT CITY, MD 21043-4555
(410) 660-5924
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501013765
MI
Other
Enumeration date
02/12/2009
Last updated
02/12/2009
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