Provider Demographics
NPI:1295153526
Name:QUEENSBERRY, VALERIE (PT, CLT)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:QUEENSBERRY
Suffix:
Gender:F
Credentials:PT, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9105 FRANKLIN SQUARE DR STE 106
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-5335
Mailing Address - Country:US
Mailing Address - Phone:443-777-7750
Mailing Address - Fax:443-777-8184
Practice Address - Street 1:9105 FRANKLIN SQUARE DR STE 106
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-5335
Practice Address - Country:US
Practice Address - Phone:443-777-7750
Practice Address - Fax:443-777-8184
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-03
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15851225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist