=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033295357
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GARY L PERSING PT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/29/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1005 RIVER RD
-----------------------------------------------------
City | SYKESVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21784-5512
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-538-5085
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 235
-----------------------------------------------------
City | WEST FRIENDSHIP
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21794-0235
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-538-5085
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 15439
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------