Healthcare Provider Details

I. General information

NPI: 1558714824
Provider Name (Legal Business Name): PROFLEX PHYSICAL THERAPY OF MARYLAND, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2016
Last Update Date: 09/19/2022
Certification Date: 09/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3320 CRAIN HWY
WALDORF MD
20603-4850
US

IV. Provider business mailing address

PO BOX 791217
BALTIMORE MD
21279-1217
US

V. Phone/Fax

Practice location:
  • Phone: 301-870-7366
  • Fax: 301-870-6717
Mailing address:
  • Phone: 301-932-4785
  • Fax: 301-932-4789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KATHY HEIER
Title or Position: DIRECTOR OF BILLING
Credential:
Phone: 301-932-4785