Provider Demographics
NPI:1083810295
Name:DZIEKETEY, NADINE T (PT)
Entity Type:Individual
Prefix:MRS
First Name:NADINE
Middle Name:T
Last Name:DZIEKETEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710 BARNWOOD CT
Mailing Address - Street 2:
Mailing Address - City:SEVERN
Mailing Address - State:MD
Mailing Address - Zip Code:21144-6804
Mailing Address - Country:US
Mailing Address - Phone:410-846-5743
Mailing Address - Fax:
Practice Address - Street 1:9801 BROKENLAND PKWY
Practice Address - Street 2:SUITE 103
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-3080
Practice Address - Country:US
Practice Address - Phone:800-533-3632
Practice Address - Fax:800-232-3575
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20179225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist