Healthcare Provider Details

I. General information

NPI: 1528665262
Provider Name (Legal Business Name): AH CONCIERGE PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2020
Last Update Date: 12/23/2022
Certification Date: 12/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8076 WINDWARD KEY DR
CHESAPEAKE BEACH MD
20732-3185
US

IV. Provider business mailing address

8076 WINDWARD KEY DR
CHESAPEAKE BEACH MD
20732-3185
US

V. Phone/Fax

Practice location:
  • Phone: 410-934-4028
  • Fax: 410-609-9968
Mailing address:
  • Phone: 410-934-4028
  • Fax: 410-609-9968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: TANYA LYNN KELLY
Title or Position: MANAGER
Credential:
Phone: 410-934-4028