Provider Demographics
NPI:1386274678
Name:ABENOJA, MAUREEN GONZALES (PT,DPT,CLT)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:GONZALES
Last Name:ABENOJA
Suffix:
Gender:F
Credentials:PT,DPT,CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 WASHINGTON AVE APT 706
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-4720
Mailing Address - Country:US
Mailing Address - Phone:443-938-7194
Mailing Address - Fax:
Practice Address - Street 1:212 WASHINGTON AVE APT 706
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-4720
Practice Address - Country:US
Practice Address - Phone:443-938-7194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-25
Last Update Date:2020-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22479225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist