Healthcare Provider Details

I. General information

NPI: 1326873506
Provider Name (Legal Business Name): TINY TOTS THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2024
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6512 HAZEL THICKET DR
COLUMBIA MD
21044-6047
US

IV. Provider business mailing address

6512 HAZEL THICKET DR
COLUMBIA MD
21044-6047
US

V. Phone/Fax

Practice location:
  • Phone: 443-286-5654
  • Fax:
Mailing address:
  • Phone: 443-286-5654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. JILL TARA HARTMAN
Title or Position: PHYSICAL THERAPIST
Credential:
Phone: 443-286-5654