Healthcare Provider Details

I. General information

NPI: 1386286987
Provider Name (Legal Business Name): LHMG PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2019
Last Update Date: 05/24/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 MAIN ST STE 109
CHESTER MD
21619-2792
US

IV. Provider business mailing address

2001 MEDICAL PKWY OFC
ANNAPOLIS MD
21401-3773
US

V. Phone/Fax

Practice location:
  • Phone: 443-481-1140
  • Fax:
Mailing address:
  • Phone: 443-481-5618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: PETER ODENWALD
Title or Position: SENIOR MANAGER
Credential:
Phone: 443-481-6415