Healthcare Provider Details

I. General information

NPI: 1407441025
Provider Name (Legal Business Name): PERSONALIZED PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2021
Last Update Date: 03/05/2021
Certification Date: 03/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1507 RITCHIE HWY SUITE 101
ARNOLD MD
21012
US

IV. Provider business mailing address

1507 RITCHIE HWY SUITE 101
ARNOLD MD
21012
US

V. Phone/Fax

Practice location:
  • Phone: 302-345-7202
  • Fax:
Mailing address:
  • Phone: 302-345-7202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: KELSEY VAGNONI
Title or Position: PHYSICAL THERAPIST
Credential: DPT
Phone: 302-345-7202