Basic Information
| Provider Information | |||||||||
| NPI: | 1972721199 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOLDER | ||||||||
| FirstName: | MONICA | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 179 | ||||||||
| Address2: | |||||||||
| City: | FOREST HILL | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210500179 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107957878 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1388 PROGRESS WAY | ||||||||
| Address2: | |||||||||
| City: | ELDERSBURG | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217846463 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107957878 | ||||||||
| FaxNumber: | 4107957879 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2007 | ||||||||
| LastUpdateDate: | 11/04/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 16456 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 2251X0800X | 16456 | MD | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic |
No ID Information.