Provider Demographics
NPI:1356575898
Name:HOWARD, MARY JEAN (MPT)
Entity type:Individual
Prefix:MRS
First Name:MARY JEAN
Middle Name:
Last Name:HOWARD
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 W DIAMOND AVE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-1419
Mailing Address - Country:US
Mailing Address - Phone:301-315-3030
Mailing Address - Fax:
Practice Address - Street 1:820 W DIAMOND AVE
Practice Address - Street 2:SUITE 600
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-1419
Practice Address - Country:US
Practice Address - Phone:301-315-3030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-12
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23142225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist