Healthcare Provider Details

I. General information

NPI: 1043217524
Provider Name (Legal Business Name): ERGONOMICALLY CORRECT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 10/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

788 ROLLING VIEW DR
ANNAPOLIS MD
21409-4655
US

IV. Provider business mailing address

134 HOLIDAY CT SUITE 309
ANNAPOLIS MD
21401-7008
US

V. Phone/Fax

Practice location:
  • Phone: 443-994-1251
  • Fax:
Mailing address:
  • Phone: 410-573-5733
  • Fax: 410-897-9118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number19655
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2251E1200X
TaxonomyErgonomics Physical Therapist
License Number19655
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number19655
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number19655
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number19655
License Number StateMD
# 6
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number19655
License Number StateMD

VIII. Authorized Official

Name: MR. DAVID ANDREW FLETCHER
Title or Position: OWNER
Credential: PT
Phone: 410-573-5733