Provider Demographics
NPI:1891840468
Name:MASTBOOM-BELL, PAULA (PT)
Entity Type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:
Last Name:MASTBOOM-BELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:551 BALTIMORE ANNAPOLIS BLVD # F
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-3809
Mailing Address - Country:US
Mailing Address - Phone:410-315-9080
Mailing Address - Fax:410-315-9012
Practice Address - Street 1:551 BALTIMORE ANNAPOLIS BLVD # F
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-3809
Practice Address - Country:US
Practice Address - Phone:410-315-9080
Practice Address - Fax:410-315-9012
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21732225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS429OtherBLUE SHIELD DC
MDKBX3OtherBLUE SHIELD MD
MDG01032Medicare ID - Type Unspecified