Provider Demographics
NPI:1750881520
Name:DORSEY-WORTHY, CENTRIA S (LMT)
Entity type:Individual
Prefix:MRS
First Name:CENTRIA
Middle Name:S
Last Name:DORSEY-WORTHY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:CENTRIA
Other - Middle Name:S
Other - Last Name:DORSEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:1927 PARK AVE APT D1
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21217-4827
Mailing Address - Country:US
Mailing Address - Phone:443-204-2251
Mailing Address - Fax:
Practice Address - Street 1:1927 PARK AVE APT D1
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21217-4827
Practice Address - Country:US
Practice Address - Phone:443-204-2251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM04768225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDM04768OtherSTATE LICENSE
MDRC2134OtherSTATE CERTIFICATION