Healthcare Provider Details

I. General information

NPI: 1811599616
Provider Name (Legal Business Name): ALPHA PROJECT PHYZIO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2020
Last Update Date: 01/07/2021
Certification Date: 01/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4920B MERIDIAN WAY APT 22
FREDERICK MD
21703-6898
US

IV. Provider business mailing address

4920B MERIDIAN WAY APT 22
FREDERICK MD
21703-6898
US

V. Phone/Fax

Practice location:
  • Phone: 315-271-8675
  • Fax:
Mailing address:
  • Phone: 315-271-8675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MATTHEW SILVER
Title or Position: CEO/ OWNER
Credential: DPT
Phone: 315-271-8675