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General NPI Number Information
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NPI Number | 1144637570
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Entity Type | Organization
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Legal Business Name | 4 OAKS PHYSICAL THERAPY, LLC.
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Dates
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Enumeration Date | 07/17/2014
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Last Update Date | 01/07/2026
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Provider Practice Location Address
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Address Line | 10632 LITTLE PATUXENT PKWY SUITE 123
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City | COLUMBIA
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State | MD
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Zip | 21044-3273
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Country | US
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Telephone | 443-917-2973
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Fax | 443-917-2983
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Provider Business Mailing Address
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Address Line | PO BOX 52405
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City | PHOENIX
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State | AZ
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Zip | 85072-2405
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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 | CREDENTIALING MANAGER
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Name | ANNA GAYLORD
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Credential |
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Telephone | 678-837-7176
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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 | 19806
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License Number State | MD
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