Basic Information
| Provider Information | |||||||||
| NPI: | 1447300157 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MUIR | ||||||||
| FirstName: | EDWARD | ||||||||
| MiddleName: | ALLEN | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 WHITEMARSH PARK DRIVE | ||||||||
| Address2: | |||||||||
| City: | BOWIE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 20715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3012625852 | ||||||||
| FaxNumber: | 3012623173 | ||||||||
| Practice Location | |||||||||
| Address1: | 551F BALTIMORE ANNAPOLIS BLVD | ||||||||
| Address2: | |||||||||
| City: | SEVERNA PARK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211463809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103159080 | ||||||||
| FaxNumber: | 4103159012 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2007 | ||||||||
| LastUpdateDate: | 04/15/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251X0800X | 21514 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic |
No ID Information.