Provider Demographics
NPI:1336747930
Name:WOHLBERG, MELISSA (PT, DPT, RY200)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:WOHLBERG
Suffix:
Gender:F
Credentials:PT, DPT, RY200
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:WOHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1700 REISTERSTOWN RD STE 109
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-2978
Mailing Address - Country:US
Mailing Address - Phone:410-908-5595
Mailing Address - Fax:
Practice Address - Street 1:1700 REISTERSTOWN RD STE 109
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-2978
Practice Address - Country:US
Practice Address - Phone:410-908-5595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD224842251N0400X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology