Provider Demographics
NPI:1366075483
Name:GRADY, KATHERINE MARY (PT, MS)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:MARY
Last Name:GRADY
Suffix:
Gender:F
Credentials:PT, MS
Other - Prefix:MRS
Other - First Name:KATHERINE
Other - Middle Name:MARY
Other - Last Name:GRADY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, MS
Mailing Address - Street 1:213 BEACHSIDE DR
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21666-3913
Mailing Address - Country:US
Mailing Address - Phone:443-223-0126
Mailing Address - Fax:
Practice Address - Street 1:7310 RITCHIE HWY STE 615
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-3291
Practice Address - Country:US
Practice Address - Phone:410-766-0006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-17
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19413225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist