=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396725032
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KASSIMIR PHYSICAL THERAPY, P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/19/2006
-----------------------------------------------------
Last Update Date | 01/05/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1777 REISTERSTOWN RD SUITE 130
-----------------------------------------------------
City | PIKESVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21208-1306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-415-5905
-----------------------------------------------------
Fax | 410-415-5906
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1777 REISTERSTOWN RD SUITE 130
-----------------------------------------------------
City | PIKESVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21208-1306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-415-5905
-----------------------------------------------------
Fax | 410-415-5906
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | GARY D. KASSIMIR
-----------------------------------------------------
Credential | P.T., C.H.T.
-----------------------------------------------------
Telephone | 410-415-5905
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332BC3200X
-----------------------------------------------------
Taxonomy Name | Customized Equipment (DME)
-----------------------------------------------------
License Number | 16224
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------