Healthcare Provider Details

I. General information

NPI: 1578640025
Provider Name (Legal Business Name): PHYSIOTHERAPY ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2076 LORD BALTIMORE DR
BALTIMORE MD
21244-2501
US

IV. Provider business mailing address

211 NORTH ST
ELKTON MD
21921-5512
US

V. Phone/Fax

Practice location:
  • Phone: 410-944-9445
  • Fax: 410-944-9978
Mailing address:
  • Phone: 410-620-4795
  • Fax: 410-620-4869

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: ROB ZIGENFUS
Title or Position: CONTRACTING
Credential:
Phone: 901-685-7227