Provider Demographics
NPI:1487053534
Name:MUEHLENKAMP, MARA ELIZABETH (DPT)
Entity type:Individual
Prefix:
First Name:MARA
Middle Name:ELIZABETH
Last Name:MUEHLENKAMP
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MARA
Other - Middle Name:ELIZABETH
Other - Last Name:MUEHLENKAMP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:3455 HIGHWAY 81 SOUTH
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-3918
Mailing Address - Country:US
Mailing Address - Phone:770-554-0665
Mailing Address - Fax:770-554-0685
Practice Address - Street 1:998 HOSPITALITY WAY
Practice Address - Street 2:SUITE 101
Practice Address - City:ABERDEEN
Practice Address - State:MD
Practice Address - Zip Code:21001
Practice Address - Country:US
Practice Address - Phone:410-273-9776
Practice Address - Fax:410-273-9777
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDPT25161225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist