Provider Demographics
NPI:1104562537
Name:COUNTISS, MIA A (PT, DPT)
Entity type:Individual
Prefix:
First Name:MIA
Middle Name:A
Last Name:COUNTISS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7530 ABBINGTON DR
Mailing Address - Street 2:
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-1509
Mailing Address - Country:US
Mailing Address - Phone:301-377-2524
Mailing Address - Fax:
Practice Address - Street 1:11701 LIVINGSTON RD STE 202
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-5136
Practice Address - Country:US
Practice Address - Phone:110-456-2537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-09
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist