Healthcare Provider Details

I. General information

NPI: 1225650633
Provider Name (Legal Business Name): BIRCH TREE PHYSICAL THERAPY AND WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2020
Last Update Date: 05/08/2020
Certification Date: 05/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 GIRARD AVE
BALTIMORE MD
21211-1595
US

IV. Provider business mailing address

611 S PACA ST
BALTIMORE MD
21230-2411
US

V. Phone/Fax

Practice location:
  • Phone: 443-977-4470
  • Fax:
Mailing address:
  • Phone: 443-801-1472
  • Fax:

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: DR. SEAN VINCENT MCCOMISKEY
Title or Position: OWNER, PHYSICAL THERAPIST
Credential: PT, DPT
Phone: 443-977-4470