Basic Information
| Provider Information | |||||||||
| NPI: | 1366765364 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MEYERS | ||||||||
| FirstName: | CAROLYN | ||||||||
| MiddleName: | COOK | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9492 DEERECO RD | ||||||||
| Address2: | |||||||||
| City: | LUTHERVILLE TIMONIUM | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210932102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103087182 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2634 BRANDERMILL BLVD | ||||||||
| Address2: | |||||||||
| City: | GAMBRILLS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210541651 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107217201 | ||||||||
| FaxNumber: | 4107217580 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/04/2010 | ||||||||
| LastUpdateDate: | 02/18/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 23192 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.