Provider Demographics
NPI:1629011499
Name:KOTROBA, ELIZABETH MARIE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:MARIE
Last Name:KOTROBA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:MISS
Other - First Name:ELIZABETH
Other - Middle Name:MARIE
Other - Last Name:CISSEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:3901 NATIONAL DR STE 100
Mailing Address - Street 2:
Mailing Address - City:BURTONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20866-1176
Mailing Address - Country:US
Mailing Address - Phone:301-421-1125
Mailing Address - Fax:
Practice Address - Street 1:9909 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-6361
Practice Address - Country:US
Practice Address - Phone:240-864-6036
Practice Address - Fax:240-864-6209
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21503225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD40707550Medicaid
MD213029Medicare UPIN