Healthcare Provider Details

I. General information

NPI: 1437559580
Provider Name (Legal Business Name): PHYSIOTHERAPY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2014
Last Update Date: 08/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4924 CAMPBELL BLVD SUITE 130A
NOTTINGHAM MD
21236-5908
US

IV. Provider business mailing address

4924 CAMPBELL BLVD SUITE 130A
NOTTINGHAM MD
21236-5908
US

V. Phone/Fax

Practice location:
  • Phone: 610-884-4814
  • Fax:
Mailing address:
  • Phone: 610-884-4814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number21190
License Number StateMD

VIII. Authorized Official

Name: PAM RICE
Title or Position: HR
Credential:
Phone: 610-644-7824