Healthcare Provider Details

I. General information

NPI: 1144637570
Provider Name (Legal Business Name): 4 OAKS PHYSICAL THERAPY, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2014
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10632 LITTLE PATUXENT PKWY SUITE 123
COLUMBIA MD
21044-3273
US

IV. Provider business mailing address

PO BOX 52405
PHOENIX AZ
85072-2405
US

V. Phone/Fax

Practice location:
  • Phone: 443-917-2973
  • Fax: 443-917-2983
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number19806
License Number StateMD

VIII. Authorized Official

Name: ANNA GAYLORD
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 678-837-7176