MEDICARE: PHYSICAL THERAPY DYNAMICS, INC

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	19648	MD

General Provider Information

NPI Number	:	1285688895
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICAL THERAPY DYNAMICS, INC

Provider Business Mailing Address
First Line	:	5236 TALBOTS LNDG
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-6845
Country	:	US
Telephone Number	:	443-878-0622
Fax Number	:

Provider Business Practice Location Address
First Line	:	5236 TALBOTS LNDG
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-6845
Country	:	US
Telephone Number	:	443-878-0622
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	BRENDA A RUTLEDGE
Credential	:	MPT
Telephone Number	:	434-878-0622

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	03/22/2019

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