Healthcare Provider Details

I. General information

NPI: 1750769055
Provider Name (Legal Business Name): LHMG PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2015
Last Update Date: 05/24/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4175 N HANSON CT SUITE 301
BOWIE MD
20716-3179
US

IV. Provider business mailing address

2000 MEDICAL PKWY SUITE 101
ANNAPOLIS MD
21401-3742
US

V. Phone/Fax

Practice location:
  • Phone: 301-805-7004
  • Fax: 301-352-0173
Mailing address:
  • Phone: 410-268-8862
  • Fax: 410-280-4701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: PETER ODENWALD
Title or Position: VICE PRESIDENT
Credential:
Phone: 443-481-6415