Healthcare Provider Details

I. General information

NPI: 1053868927
Provider Name (Legal Business Name): PROFLEX PHYSICAL THERAPY OF MARYLAND, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2016
Last Update Date: 09/19/2022
Certification Date: 09/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7905 MALCOLM RD 201
CLINTON MD
20735-1734
US

IV. Provider business mailing address

PO BOX 791217
BALTIMORE MD
21279-1217
US

V. Phone/Fax

Practice location:
  • Phone: 301-856-0050
  • Fax: 301-856-0518
Mailing address:
  • Phone: 301-932-4786
  • Fax: 301-932-4789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KATHY HEIER
Title or Position: DIRECTOR OF BILLING
Credential:
Phone: 301-932-4785