Healthcare Provider Details

I. General information

NPI: 1639574502
Provider Name (Legal Business Name): WITH KIDS IN MIND THERAPY SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2014
Last Update Date: 11/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 LINCOLN DR
ANNAPOLIS MD
21401-4118
US

IV. Provider business mailing address

1911 LINCOLN DR
ANNAPOLIS MD
21401-4118
US

V. Phone/Fax

Practice location:
  • Phone: 410-573-1064
  • Fax: 410-573-1065
Mailing address:
  • Phone: 410-573-1064
  • Fax: 410-573-1065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number17012
License Number StateMD

VIII. Authorized Official

Name: RENEE MICHELLE HILLMANN PRENTICE
Title or Position: OWNER
Credential: PT
Phone: 410-573-1064