Healthcare Provider Details

I. General information

NPI: 1497072847
Provider Name (Legal Business Name): SOUTHERN MARYLAND PHYSICAL THERAPY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2010
Last Update Date: 03/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10401 HOSPITAL DR SUITE 102
CLINTON MD
20735-3110
US

IV. Provider business mailing address

7503 SURRATTS RD
CLINTON MD
20735-3358
US

V. Phone/Fax

Practice location:
  • Phone: 301-856-0050
  • Fax: 301-856-0518
Mailing address:
  • Phone: 301-870-7001
  • Fax: 301-870-6697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. MICHAEL JAMES CHIARAMONTE
Title or Position: PRESIDENT
Credential:
Phone: 301-877-4530