Provider Demographics
NPI:1114355898
Name:POKRYFKI, RETHA (LMT)
Entity Type:Individual
Prefix:
First Name:RETHA
Middle Name:
Last Name:POKRYFKI
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6045A MELBOURNE AVENUE
Mailing Address - Street 2:
Mailing Address - City:DEALE
Mailing Address - State:MD
Mailing Address - Zip Code:20751
Mailing Address - Country:US
Mailing Address - Phone:443-203-9827
Mailing Address - Fax:
Practice Address - Street 1:6045 MELBOURNE AVENUE
Practice Address - Street 2:#A
Practice Address - City:DEALE
Practice Address - State:MD
Practice Address - Zip Code:20751
Practice Address - Country:US
Practice Address - Phone:443-203-9827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-16
Last Update Date:2013-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM05092225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist