Healthcare Provider Details

I. General information

NPI: 1922737238
Provider Name (Legal Business Name): FELICE PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2022
Last Update Date: 06/10/2022
Certification Date: 06/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1834 GEORGE AVE
ANNAPOLIS MD
21401-4103
US

IV. Provider business mailing address

11270 PEPPER RD
HUNT VALLEY MD
21031-1202
US

V. Phone/Fax

Practice location:
  • Phone: 443-441-0631
  • Fax: 443-320-4125
Mailing address:
  • Phone: 814-502-6532
  • Fax: 443-320-4125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JEROD MICHAEL FELICE
Title or Position: OWNER
Credential:
Phone: 315-408-8341