Provider Demographics
NPI:1386641793
Name:PAREZO, COURTNEY BRYANT (DPT)
Entity Type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:BRYANT
Last Name:PAREZO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:ELIZABETH
Other - Last Name:BRYANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2 W ROLLING XRDS STE 100-102
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-6211
Mailing Address - Country:US
Mailing Address - Phone:410-747-1600
Mailing Address - Fax:410-747-5202
Practice Address - Street 1:2 W ROLLING CROSSROADS
Practice Address - Street 2:SUITE 102
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21228-6208
Practice Address - Country:US
Practice Address - Phone:410-747-1600
Practice Address - Fax:410-747-5202
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2024-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20475225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD2128350OtherMAMSI
MD224004100Medicaid
MDH370D410Medicare ID - Type Unspecified