Healthcare Provider Details

I. General information

NPI: 1073859476
Provider Name (Legal Business Name): CHESAPEAKE BAY AQUATIC & PHYSICAL THERAPY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2012
Last Update Date: 11/12/2020
Certification Date: 11/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9475 DEERECO RD STE 102
TIMONIUM MD
21093-2124
US

IV. Provider business mailing address

PO BOX 4058
CROFTON MD
21114-4058
US

V. Phone/Fax

Practice location:
  • Phone: 410-308-3543
  • Fax: 410-308-4661
Mailing address:
  • Phone: 301-262-5852
  • Fax: 301-262-3173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: DANIELLE GOLDSTEIN
Title or Position: DIRECTOR OF OPERATIONS
Credential: DPT
Phone: 301-498-2212