Provider Demographics
NPI:1023396116
Name:PICKETT, MARIJO (PTA)
Entity Type:Individual
Prefix:MRS
First Name:MARIJO
Middle Name:
Last Name:PICKETT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MS
Other - First Name:MARIJO
Other - Middle Name:
Other - Last Name:BIRKHIMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:9099 RIDGEFIELD DR STE 202
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-6720
Mailing Address - Country:US
Mailing Address - Phone:301-696-5595
Mailing Address - Fax:301-696-0846
Practice Address - Street 1:65 THOMAS JOHNSON DR STE D
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4371
Practice Address - Country:US
Practice Address - Phone:301-663-7898
Practice Address - Fax:301-663-7793
Is Sole Proprietor?:No
Enumeration Date:2011-07-25
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA3402225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant