Provider Demographics
NPI:1609945435
Name:DALY, KATHLEEN M (PT)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:M
Last Name:DALY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:KATHLEEN
Other - Middle Name:M
Other - Last Name:RYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3632 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:PORT REPUBLIC
Mailing Address - State:MD
Mailing Address - Zip Code:20676-2331
Mailing Address - Country:US
Mailing Address - Phone:410-257-2774
Mailing Address - Fax:
Practice Address - Street 1:11750 ASBURY CIR
Practice Address - Street 2:
Practice Address - City:SOLOMONS
Practice Address - State:MD
Practice Address - Zip Code:20688-3058
Practice Address - Country:US
Practice Address - Phone:410-394-3066
Practice Address - Fax:410-394-3566
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15675225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist