Provider Demographics
NPI:1558926238
Name:ROSE, MANDY DINKIN (DPT)
Entity type:Individual
Prefix:DR
First Name:MANDY
Middle Name:DINKIN
Last Name:ROSE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8707 VALLEYFIELD RD
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-4002
Mailing Address - Country:US
Mailing Address - Phone:301-613-9565
Mailing Address - Fax:
Practice Address - Street 1:600 WYNDHURST AVE STE 102
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21210-2424
Practice Address - Country:US
Practice Address - Phone:410-601-3991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-07
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD29184225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist