Healthcare Provider Details

I. General information

NPI: 1275684185
Provider Name (Legal Business Name): KENILWORTH THERAPEUTIC SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 RITCHIE HWY STE N7
SEVERNA PARK MD
21146-4128
US

IV. Provider business mailing address

760 RITCHIE HWY STE N7
SEVERNA PARK MD
21146-4128
US

V. Phone/Fax

Practice location:
  • Phone: 443-906-6070
  • Fax: 443-906-6050
Mailing address:
  • Phone: 443-906-6070
  • Fax: 443-906-6050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number14719
License Number StateMD

VIII. Authorized Official

Name: JENNIFER ANGELES
Title or Position: OWNER
Credential: P.T.
Phone: 443-906-6070