Provider Demographics
NPI:1497755300
Name:THORSEN, MARY (PT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:THORSEN
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 1:731 BALTIMORE BLVD
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-6105
Mailing Address - Country:US
Mailing Address - Phone:410-848-8628
Mailing Address - Fax:410-848-3909
Practice Address - Street 1:19 W FREDERICK ST
Practice Address - Street 2:
Practice Address - City:WALKERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21793-8230
Practice Address - Country:US
Practice Address - Phone:301-845-0045
Practice Address - Fax:301-845-0045
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17003225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
322679OtherMAMSI PLANS
5060511OtherAETNA NON HMO
DCT615-0008OtherCAREFIRST BLUECHOICE
2118118OtherAETNA HMO
MDH481DO-53189902OtherCAREFIRST BLUECROSS
DCT615-0008OtherCAREFIRST BLUECHOICE