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Organization

MANUAL PT & SPORTS MEDICINE

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. SUSAN ELIZABETH ROVNAK PHYSICAL THERAPIST (CEO)
(410) 889-8004
Entity
Organization

Contact information

Practice address
3612 FALLS RD LOWR LEVEL, BALTIMORE, MD 21211-1814
(410) 889-8004
(410) 889-8024
Mailing address
PO BOX 50105, BALTIMORE, MD 21211-4105
(410) 889-8004
(410) 889-8024

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
16168
MD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
J353MA
CAREFIRST BC/BS MARYLAND
MD
Enumeration date
07/18/2005
Last updated
02/28/2008
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