Healthcare Provider Details

I. General information

NPI: 1902990682
Provider Name (Legal Business Name): PHYSIOTHERAPY ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 06/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 THOMAS JOHNSON DR SUITE 104
FREDERICK MD
21702-4354
US

IV. Provider business mailing address

665 PHILADELPHIA ST
INDIANA PA
15701-3941
US

V. Phone/Fax

Practice location:
  • Phone: 301-662-7496
  • Fax: 301-663-4936
Mailing address:
  • Phone: 724-465-3496
  • Fax: 215-413-4682

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: MRS. JAYNE FLECK POOL
Title or Position: CHIEF COMPLIANCE OFFICER
Credential:
Phone: 469-467-8705