MEDICARE: KEVIN CHARLES PLATT PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	18237	MD

General Provider Information

NPI Number	:	1053330357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN CHARLES PLATT PT

Provider Business Mailing Address
First Line	:	5342 KERGER RD
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-8207
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	65 THOMAS JOHNSON DR STE D
Second Line	:
City	:	FREDERICK
State	:	MD
Zip	:	21702-4371
Country	:	US
Telephone Number	:	301-663-7898
Fax Number	:	301-663-7793

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	07/08/2007

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