Healthcare Provider Details

I. General information

NPI: 1902408511
Provider Name (Legal Business Name): AGAPE PHYSICAL THERAPY & SPORTS REHABILITATION LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2020
Last Update Date: 11/12/2020
Certification Date: 11/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 NEWPORT DR STE A
FOREST HILL MD
21050-1758
US

IV. Provider business mailing address

12 NEWPORT DR STE A
FOREST HILL MD
21050-1758
US

V. Phone/Fax

Practice location:
  • Phone: 410-838-9600
  • Fax:
Mailing address:
  • Phone: 410-838-9600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: RICHARD BINSTEIN
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 713-297-7000