Provider Demographics
NPI:1861619371
Name:MUELLER, MARYROSE LEE (PT)
Entity type:Individual
Prefix:
First Name:MARYROSE
Middle Name:LEE
Last Name:MUELLER
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 1:203 COUNTRY CHASE CT
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-2628
Mailing Address - Country:US
Mailing Address - Phone:410-768-8612
Mailing Address - Fax:
Practice Address - Street 1:3330 WILKENS AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-4610
Practice Address - Country:US
Practice Address - Phone:410-525-1544
Practice Address - Fax:410-646-1910
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14742225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist