Healthcare Provider Details

I. General information

NPI: 1104355189
Provider Name (Legal Business Name): LHMG PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2017
Last Update Date: 05/24/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 DUTCHMANS LN STE A2
EASTON MD
21601-4302
US

IV. Provider business mailing address

8638 VETERANS HWY FL 1
MILLERSVILLE MD
21108-1422
US

V. Phone/Fax

Practice location:
  • Phone: 410-822-2440
  • Fax: 410-822-2441
Mailing address:
  • Phone: 667-204-7051
  • Fax: 443-481-6515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: PETER ODENWALD
Title or Position: VICE PRESIDENT
Credential:
Phone: 443-481-6415