Healthcare Provider Details

I. General information

NPI: 1609877646
Provider Name (Legal Business Name): SOUTHERN MARYLAND PHYSICAL THERAPY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2005
Last Update Date: 04/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 SAINT PATRICKS DR SUITE 401
WALDORF MD
20603-4527
US

IV. Provider business mailing address

10 SAINT PATRICKS DR SUITE 401
WALDORF MD
20603-4527
US

V. Phone/Fax

Practice location:
  • Phone: 301-870-7366
  • Fax: 301-870-6717
Mailing address:
  • Phone: 301-870-7366
  • Fax: 301-870-6717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: KATHY M HEIER
Title or Position: PRACTICE MANAGER
Credential:
Phone: 301-870-7366