Provider Demographics
NPI:1083026769
Name:MASSEY, ANNELIESE H (MPT)
Entity Type:Individual
Prefix:
First Name:ANNELIESE
Middle Name:H
Last Name:MASSEY
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5601 LOCH RAVEN BLVD
Mailing Address - Street 2:O'NEILL BLDG, SECOND FLOOR (CORS)
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21239-2945
Mailing Address - Country:US
Mailing Address - Phone:443-444-5500
Mailing Address - Fax:443-444-4607
Practice Address - Street 1:5601 LOCH RAVEN BLVD
Practice Address - Street 2:O'NEILL BLDG, SECOND FLOOR (CORS)
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239-2945
Practice Address - Country:US
Practice Address - Phone:443-444-5500
Practice Address - Fax:443-444-4607
Is Sole Proprietor?:No
Enumeration Date:2014-05-29
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD188722251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology