Miss Taila Dane De Souza, DPT | |
4062 Rustico Rd, Middle River, MD 21220-2342 | |
(410) 335-7898 | |
Not Available |
Full Name | Miss Taila Dane De Souza |
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Gender | Female |
Speciality | Physical Therapist |
Location | 4062 Rustico Rd, Middle River, Maryland |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1780016303 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
225100000X | Physical Therapist | 24568 (Maryland) | Primary |
Provider Name | Salus Capital Inc |
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Provider Type | Part B Supplier - Clinic/group Practice |
Provider Identifiers | NPI Number: 1568859478 PECOS PAC ID: 6103131198 Enrollment ID: O20151008000415 |
Mailing Address | Practice Location Address |
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Miss Taila Dane De Souza, DPT 4062 Rustico Rd, Middle River, MD 21220-2342 Ph: (410) 335-7898 | Miss Taila Dane De Souza, DPT 4062 Rustico Rd, Middle River, MD 21220-2342 Ph: (410) 335-7898 |
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