Healthcare Provider Details

I. General information

NPI: 1124117916
Provider Name (Legal Business Name): ATLANTIC PHYSICAL THERAPY REHABILITATION AND SPORTS MEDICINE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 11/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11070 CATHELL RD UNIT 4
BERLIN MD
21811-9344
US

IV. Provider business mailing address

11070 CATHELL RD UNIT 4
BERLIN MD
21811-9344
US

V. Phone/Fax

Practice location:
  • Phone: 410-208-3630
  • Fax: 410-208-3632
Mailing address:
  • Phone: 410-208-3630
  • Fax: 410-208-3632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: ROBIN CUMMINGS
Title or Position: OFFICE MANAGER
Credential:
Phone: 410-208-3630