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General NPI Number Information
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NPI Number | 1134870116
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Entity Type | Organization
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Legal Business Name | KIDNETIC PHYSICAL THERAPY - LLC
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Dates
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Enumeration Date | 01/12/2022
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Last Update Date | 04/18/2023
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Provider Practice Location Address
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Address Line | 2227 OLD EMMORTON RD STE 121
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City | BEL AIR
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State | MD
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Zip | 21015-6190
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Country | US
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Telephone | 443-752-4711
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Fax |
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Provider Business Mailing Address
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Address Line | 8238 PHILADELPHIA RD
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City | BALTIMORE
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State | MD
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Zip | 21237-2833
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GABRIELLA DEJULIIS
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Credential |
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Telephone | 410-627-1325
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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