Provider Demographics
NPI:1497129423
Name:FEDORKO, BRIANA (DPT)
Entity Type:Individual
Prefix:
First Name:BRIANA
Middle Name:
Last Name:FEDORKO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:BRIANA
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:501 FAIRMOUNT AVE
Mailing Address - Street 2:STE 302
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-5457
Mailing Address - Country:US
Mailing Address - Phone:410-927-8768
Mailing Address - Fax:
Practice Address - Street 1:314 FRANKLIN AVE
Practice Address - Street 2:SUITE 501
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-1215
Practice Address - Country:US
Practice Address - Phone:410-641-0999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-13
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25766225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist