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General NPI Number Information
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NPI Number | 1184118713
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Entity Type | Individual
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Provider Name | MICHAEL STANGROOM DPT
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Gender | Male
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Dates
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Enumeration Date | 06/18/2018
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Last Update Date | 04/01/2025
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Provider Practice Location Address
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Address Line | 2021A EMMORTON RD STE 110
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City | BEL AIR
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State | MD
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Zip | 21015-8914
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Country | US
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Telephone | 410-515-0006
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Fax | 410-515-0027
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Provider Business Mailing Address
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Address Line | 2001 BUTTERFIELD RD STE 1600
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-1211
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 2305211989
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State | MD
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