Healthcare Provider Details

I. General information

NPI: 1942208186
Provider Name (Legal Business Name): BARRY MICHAELSON PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 PINE RIDGE LN
PIKESVILLE MD
21208-3731
US

IV. Provider business mailing address

1309 PINE RIDGE LN
PIKESVILLE MD
21208-3731
US

V. Phone/Fax

Practice location:
  • Phone: 410-486-0275
  • Fax: 410-486-0276
Mailing address:
  • Phone: 410-486-0275
  • Fax: 410-486-0276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number17822
License Number StateMD

VIII. Authorized Official

Name: MR. BARRY SCOTT MICHAELSON
Title or Position: OWNER/OPERATOR
Credential: MPT
Phone: 410-486-0275