Provider Demographics
NPI:1285604439
Name:MOORE, MARIA ROSA (PT, MSPT, DPT)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:ROSA
Last Name:MOORE
Suffix:
Gender:F
Credentials:PT, MSPT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 791217
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21279-1217
Mailing Address - Country:US
Mailing Address - Phone:301-932-4785
Mailing Address - Fax:301-932-4789
Practice Address - Street 1:7905 MALCOM ROAD
Practice Address - Street 2:ST 201
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-2073
Practice Address - Country:US
Practice Address - Phone:301-856-0050
Practice Address - Fax:301-856-0518
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD28127225100000X
SC7737225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist