Provider Demographics
NPI:1255338661
Name:FRIEDMAN, ALYSE (PT)
Entity type:Individual
Prefix:
First Name:ALYSE
Middle Name:
Last Name:FRIEDMAN
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 1:1212 YORK RD
Mailing Address - Street 2:SUITE C-101
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-6240
Mailing Address - Country:US
Mailing Address - Phone:410-321-0377
Mailing Address - Fax:410-821-7517
Practice Address - Street 1:1212 YORK RD
Practice Address - Street 2:SUITE C-101
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-6240
Practice Address - Country:US
Practice Address - Phone:410-321-0377
Practice Address - Fax:410-821-7517
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD168732251X0800X, 2251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD472317OtherMAMSI
MD074734300Medicaid
MDP00202713OtherMEDICARE RAILROAD
MDP00202713OtherMEDICARE RAILROAD