Provider Demographics
NPI:1730417551
Name:EISGRUBER, ANDREA MARIE (PT)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:MARIE
Last Name:EISGRUBER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:MARIE
Other - Last Name:VENETZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:10989 RED RUN BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-3283
Mailing Address - Country:US
Mailing Address - Phone:410-654-7525
Mailing Address - Fax:410-654-7535
Practice Address - Street 1:10989 RED RUN BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-3283
Practice Address - Country:US
Practice Address - Phone:410-654-7525
Practice Address - Fax:410-654-7535
Is Sole Proprietor?:No
Enumeration Date:2009-12-07
Last Update Date:2014-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD227202251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
228204OtherEHP
MD6545-0020OtherGHMSI
MD963129-01OtherCAREFIRST BCBS
MD6545-0020OtherGHMSI