Healthcare Provider Details

I. General information

NPI: 1124969027
Provider Name (Legal Business Name): VIDRINE INTEGRATIVE PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2026
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 COMPASS WAY STE 208
ANNAPOLIS MD
21401-7818
US

IV. Provider business mailing address

934 RUSTLING OAKS DR
MILLERSVILLE MD
21108-1862
US

V. Phone/Fax

Practice location:
  • Phone: 443-695-8371
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: LEIGH VIDRINE
Title or Position: OWNER
Credential: PT
Phone: 281-620-3519