=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184969461
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THOMAS M. KLINE, D.C.,P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/28/2012
-----------------------------------------------------
Last Update Date | 11/28/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11637 TERRACE DR STE. 101
-----------------------------------------------------
City | WALDORF
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20602-3706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-843-1156
-----------------------------------------------------
Fax | 301-843-5917
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11637 TERRACE DR STE. 101
-----------------------------------------------------
City | WALDORF
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20602-3706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-843-1156
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. THOMAS M. KLINE
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 301-843-1156
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number | 1197PT
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------