Healthcare Provider Details

I. General information

NPI: 1508373010
Provider Name (Legal Business Name): LHMG PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2018
Last Update Date: 05/24/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 CENTRAL AVE W
EDGEWATER MD
21037-2622
US

IV. Provider business mailing address

PO BOX 15945
BELFAST ME
04915-4054
US

V. Phone/Fax

Practice location:
  • Phone: 443-481-1140
  • Fax: 410-956-0600
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: PETER ODENWALD
Title or Position: CHEIF OPERATING OFFICER
Credential:
Phone: 443-481-6415