Provider Demographics
NPI:1255665139
Name:MOUSER, ELEANOR MARIE (PT)
Entity Type:Individual
Prefix:
First Name:ELEANOR
Middle Name:MARIE
Last Name:MOUSER
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 1:5046 FRETER RD
Mailing Address - Street 2:
Mailing Address - City:SYKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21784-9307
Mailing Address - Country:US
Mailing Address - Phone:410-795-0455
Mailing Address - Fax:
Practice Address - Street 1:7309 2ND AVE
Practice Address - Street 2:
Practice Address - City:SYKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21784-7531
Practice Address - Country:US
Practice Address - Phone:410-549-6728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-25
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16075225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD16075OtherMARYLAND BOARD OF PHYSICAL THERAPY EXAMINERS