Provider Demographics
NPI:1407167893
Name:FLUCKEY, ELIZABETH ANN FAIRBAIRN (DPT)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ANN FAIRBAIRN
Last Name:FLUCKEY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10231 OLD OCEAN CITY BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811-3566
Mailing Address - Country:US
Mailing Address - Phone:410-641-2220
Mailing Address - Fax:410-629-0348
Practice Address - Street 1:10231 OLD OCEAN CITY BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-3566
Practice Address - Country:US
Practice Address - Phone:410-641-2220
Practice Address - Fax:410-629-0348
Is Sole Proprietor?:No
Enumeration Date:2010-06-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23258225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist