Healthcare Provider Details

I. General information

NPI: 1174699698
Provider Name (Legal Business Name): PROFESSIONAL HEALTH STAFFING OF MARYLAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11350 MCCORMICK RD EP 1 SUITE 503
HUNT VALLEY MD
21031-1002
US

IV. Provider business mailing address

11350 MCCORMICK RD EP 1 SUITE 503
HUNT VALLEY MD
21031-1002
US

V. Phone/Fax

Practice location:
  • Phone: 410-771-6868
  • Fax: 410-771-8444
Mailing address:
  • Phone: 410-771-6868
  • Fax: 410-771-8444

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: MS. KIMBERLY LOUISE LOCATI-BOUCHER
Title or Position: VICE PRESIDENT
Credential: OTR
Phone: 410-771-6868