Provider Demographics
NPI:1225470792
Name:WALTER, MAUREEN K (DPT)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:K
Last Name:WALTER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:K
Other - Last Name:HIRSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:3179 BRAVERTON ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:EDGEWATER
Mailing Address - State:MD
Mailing Address - Zip Code:21037-2665
Mailing Address - Country:US
Mailing Address - Phone:410-956-4308
Mailing Address - Fax:
Practice Address - Street 1:3179 BRAVERTON ST
Practice Address - Street 2:SUITE 201
Practice Address - City:EDGEWATER
Practice Address - State:MD
Practice Address - Zip Code:21037-2665
Practice Address - Country:US
Practice Address - Phone:410-956-4308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-24
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23856225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist