Provider Demographics
NPI:1497779664
Name:AMBROSE, KATHARINE CLAIRE (MSPT, DPT)
Entity Type:Individual
Prefix:MS
First Name:KATHARINE
Middle Name:CLAIRE
Last Name:AMBROSE
Suffix:
Gender:F
Credentials:MSPT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3906 LAWRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-1535
Mailing Address - Country:US
Mailing Address - Phone:240-498-8700
Mailing Address - Fax:
Practice Address - Street 1:11300 ROCKVILLE PIKE
Practice Address - Street 2:1100
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3003
Practice Address - Country:US
Practice Address - Phone:240-498-8700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21850225100000X
MA17564225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist