Provider Demographics
NPI:1871768804
Name:CRUM, MARY K (PT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:K
Last Name:CRUM
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 1:5955 QUINN ORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21704-6656
Mailing Address - Country:US
Mailing Address - Phone:301-662-6901
Mailing Address - Fax:
Practice Address - Street 1:5955 QUINN ORCHARD RD
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21704-6656
Practice Address - Country:US
Practice Address - Phone:301-662-6730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-30
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15037225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist