Healthcare Provider Details

I. General information

NPI: 1487805685
Provider Name (Legal Business Name): HAILE PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2008
Last Update Date: 03/19/2020
Certification Date: 03/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2152 RENARD CT
ANNAPOLIS MD
21401-6756
US

IV. Provider business mailing address

116 AMESBURY CT
SEVERNA PARK MD
21146-1200
US

V. Phone/Fax

Practice location:
  • Phone: 410-571-1151
  • Fax: 410-266-1513
Mailing address:
  • Phone: 410-647-7326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number16024
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. ANNE E HAILE
Title or Position: OWNER
Credential: PT
Phone: 410-571-1151