Healthcare Provider Details

I. General information

NPI: 1528614690
Provider Name (Legal Business Name): RESILIENT PHYSIOTHERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2019
Last Update Date: 08/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8303 PULASKI HWY
BALTIMORE MD
21237-2962
US

IV. Provider business mailing address

6221 GREENLEIGH AVE UNIT 515
BALTIMORE MD
21220-2038
US

V. Phone/Fax

Practice location:
  • Phone: 717-817-4308
  • Fax:
Mailing address:
  • Phone: 717-817-4308
  • 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: DR. JORDAN SHETTLE
Title or Position: DOCTORATE OF PHYSICAL THERAPY
Credential: PT, DPT
Phone: 717-817-4308