Provider Demographics
NPI:1578017489
Name:BLAXBERG, MOLLYE REBECCA (DPT)
Entity Type:Individual
Prefix:
First Name:MOLLYE
Middle Name:REBECCA
Last Name:BLAXBERG
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MOLLYE
Other - Middle Name:REBECCA
Other - Last Name:LIPTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10710 CHARTER DR
Mailing Address - Street 2:SUITE 240
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3128
Mailing Address - Country:US
Mailing Address - Phone:410-644-1880
Mailing Address - Fax:410-730-1617
Practice Address - Street 1:10710 CHARTER DR
Practice Address - Street 2:SUITE 240
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3128
Practice Address - Country:US
Practice Address - Phone:410-644-1880
Practice Address - Fax:410-730-1617
Is Sole Proprietor?:No
Enumeration Date:2016-08-09
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD26083225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist