Provider Demographics
NPI:1639609761
Name:PRIESTAS, EMILY H (DPT)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:H
Last Name:PRIESTAS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:A
Other - Last Name:HARGREAVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1165 IMPERIAL DR
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-6555
Mailing Address - Country:US
Mailing Address - Phone:301-800-7770
Mailing Address - Fax:301-800-7891
Practice Address - Street 1:1165 IMPERIAL DR STE 100
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740
Practice Address - Country:US
Practice Address - Phone:301-800-7770
Practice Address - Fax:301-800-7891
Is Sole Proprietor?:No
Enumeration Date:2017-06-12
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV003795225100000X
MD26858225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist