MEDICARE: GBMC-WP-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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1982356671
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GBMC-WP-PT

Provider Business Mailing Address
First Line	:	3411 SWEET AIR RD STE A
Second Line	:
City	:	JACKSONVILLE
State	:	MD
Zip	:	21131-1825
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3411 SWEET AIR RD STE A
Second Line	:
City	:	JACKSONVILLE
State	:	MD
Zip	:	21131-1825
Country	:	US
Telephone Number	:	410-529-3303
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JOSEPH PALMER
Credential	:
Telephone Number	:	410-842-0115

Provider Enumeration Date	:	01/24/2022
Last Update Date	:	01/24/2022

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Directions to “GBMC-WP-PT ” Practice Location

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