Provider Demographics
NPI:1588101414
Name:GROGAN, ELIZABETH SIGRIST (PTA)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:SIGRIST
Last Name:GROGAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 SHELLEY RD
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-2928
Mailing Address - Country:US
Mailing Address - Phone:443-880-5786
Mailing Address - Fax:
Practice Address - Street 1:13801 YORK RD
Practice Address - Street 2:
Practice Address - City:COCKEYSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21030-1825
Practice Address - Country:US
Practice Address - Phone:410-527-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-30
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA4624225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant