1508095944 NPI number — PAULA MARIE RICHWINE P.T., M.P.T., D.P.T.

Table of content: PAULA MARIE RICHWINE P.T., M.P.T., D.P.T. (NPI 1508095944)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508095944 NPI number — PAULA MARIE RICHWINE P.T., M.P.T., D.P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RICHWINE
Provider First Name:
PAULA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.T., M.P.T., D.P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WIRTZ
Provider Other First Name:
PAULA
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1508095944
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/07/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 179
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FOREST HILL
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21050-0179
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-838-6808
Provider Business Mailing Address Fax Number:
410-838-2511

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2304 E CHURCHVILLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEL AIR
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21015-1721
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-734-6556
Provider Business Practice Location Address Fax Number:
410-734-6557
Provider Enumeration Date:
07/07/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  22931 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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