Provider Demographics
NPI:1043680143
Name:PRICE, MARY LYNN (PT)
Entity type:Individual
Prefix:MRS
First Name:MARY LYNN
Middle Name:
Last Name:PRICE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15201 SHADY GROVE RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3217
Mailing Address - Country:US
Mailing Address - Phone:301-948-4395
Mailing Address - Fax:301-407-1860
Practice Address - Street 1:15201 SHADY GROVE RD
Practice Address - Street 2:SUITE 106
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3217
Practice Address - Country:US
Practice Address - Phone:301-948-4395
Practice Address - Fax:301-407-1860
Is Sole Proprietor?:No
Enumeration Date:2015-10-01
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16081225100000X
MD272881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical