Provider Demographics
NPI:1235101981
Name:MOORE, ROZALYN KAY (MPT, ATC)
Entity Type:Individual
Prefix:MS
First Name:ROZALYN
Middle Name:KAY
Last Name:MOORE
Suffix:
Gender:F
Credentials:MPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 CRAIN HWY S STE 401
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-6413
Mailing Address - Country:US
Mailing Address - Phone:410-768-5050
Mailing Address - Fax:410-768-7830
Practice Address - Street 1:1630 MAIN ST STE 110
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:MD
Practice Address - Zip Code:21619
Practice Address - Country:US
Practice Address - Phone:410-643-3410
Practice Address - Fax:410-643-3461
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21675225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist