Healthcare Provider Details

I. General information

NPI: 1871090118
Provider Name (Legal Business Name): OAKSTRIDE PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2018
Last Update Date: 04/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5457 TWIN KNOLLS RD STE 300
COLUMBIA MD
21045-3259
US

IV. Provider business mailing address

2104 PINEY BRANCH CIR APT 427
HANOVER MD
21076-1837
US

V. Phone/Fax

Practice location:
  • Phone: 301-605-5258
  • Fax: 888-460-0827
Mailing address:
  • Phone: 443-657-3036
  • Fax: 888-460-0827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT22490
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. OLUYEMISI A KALEJAIYE
Title or Position: OWNER/ LEAD PHYSICAL THERAPIST
Credential: PT
Phone: 443-657-3036