Provider Demographics
NPI:1710537543
Name:BIRD, MICHAELA A (DPT)
Entity Type:Individual
Prefix:
First Name:MICHAELA
Middle Name:A
Last Name:BIRD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 FAIT AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-3834
Mailing Address - Country:US
Mailing Address - Phone:443-519-8605
Mailing Address - Fax:
Practice Address - Street 1:9512 HARFORD RD STE 3
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21234-3127
Practice Address - Country:US
Practice Address - Phone:410-882-3010
Practice Address - Fax:410-882-3014
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-13
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD27677225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist