Provider Demographics
NPI:1568840098
Name:LIBDAN, AMY MARIE
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:MARIE
Last Name:LIBDAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 BELVEDERE RD APT R
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21158-3150
Mailing Address - Country:US
Mailing Address - Phone:410-513-9308
Mailing Address - Fax:
Practice Address - Street 1:5955 QUINN ORCHARD RD
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21704-6656
Practice Address - Country:US
Practice Address - Phone:301-228-2249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-17
Last Update Date:2015-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA3614225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant