Provider Demographics
NPI:1255002564
Name:ORZECH, EDEN DANIELLE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:EDEN
Middle Name:DANIELLE
Last Name:ORZECH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 DEER CROSS CT
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-5907
Mailing Address - Country:US
Mailing Address - Phone:443-851-0767
Mailing Address - Fax:
Practice Address - Street 1:2525 POT SPRING RD
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-2778
Practice Address - Country:US
Practice Address - Phone:410-561-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-26
Last Update Date:2021-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA4879225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant