Healthcare Provider Details

I. General information

NPI: 1396880100
Provider Name (Legal Business Name): POOLESVILLE PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 04/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19628 FISHER AVE
POOLESVILLE MD
20837-2065
US

IV. Provider business mailing address

19628 FISHER AVE
POOLESVILLE MD
20837-2065
US

V. Phone/Fax

Practice location:
  • Phone: 301-349-5443
  • Fax: 301-349-2074
Mailing address:
  • Phone: 301-349-5443
  • Fax: 301-349-2074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number15401
License Number StateMD

VIII. Authorized Official

Name: MRS. PATRICIA KAPSIAK HESS
Title or Position: OWNER
Credential: PT
Phone: 301-349-5443