Provider Demographics
NPI:1750992350
Name:MAMUZICH, KATRINA MARIE (AAS, PTA, COPTA)
Entity type:Individual
Prefix:MRS
First Name:KATRINA
Middle Name:MARIE
Last Name:MAMUZICH
Suffix:
Gender:F
Credentials:AAS, PTA, COPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2621 WYCLIFFE RD
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-6237
Mailing Address - Country:US
Mailing Address - Phone:610-730-4175
Mailing Address - Fax:
Practice Address - Street 1:485 RITCHIE HWY STE 202
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-2918
Practice Address - Country:US
Practice Address - Phone:410-960-1601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA4324208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation