Provider Demographics
NPI:1598914889
Name:DEBORAH A. WAHL PHYSICAL THERAPY
Entity Type:Organization
Organization Name:DEBORAH A. WAHL PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:WAHL
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:410-353-0489
Mailing Address - Street 1:638 SHORE RD
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-3428
Mailing Address - Country:US
Mailing Address - Phone:410-353-0489
Mailing Address - Fax:410-544-6166
Practice Address - Street 1:701 MORRIS TONGUE DR
Practice Address - Street 2:
Practice Address - City:MILLERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21108-2003
Practice Address - Country:US
Practice Address - Phone:410-353-0489
Practice Address - Fax:410-544-6166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20213261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation