Healthcare Provider Details

I. General information

NPI: 1497431332
Provider Name (Legal Business Name): FELICE PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7120 GOLDEN RING RD SUITE 123
BALTIMORE MD
21221
US

IV. Provider business mailing address

7120 GOLDEN RING RD SUITE 123
BALTIMORE MD
21221
US

V. Phone/Fax

Practice location:
  • Phone: 443-441-0663
  • Fax: 443-320-4125
Mailing address:
  • Phone: 443-441-0663
  • 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