Provider Demographics
NPI:1699148775
Name:LOSAK, ANN M (PT)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:M
Last Name:LOSAK
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 1:3750A SHADY LN
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:21738-9539
Mailing Address - Country:US
Mailing Address - Phone:410-970-2400
Mailing Address - Fax:410-774-4090
Practice Address - Street 1:3750A SHADY LN
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:MD
Practice Address - Zip Code:21738-9539
Practice Address - Country:US
Practice Address - Phone:410-970-2400
Practice Address - Fax:410-774-4090
Is Sole Proprietor?:No
Enumeration Date:2015-11-11
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16136225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist